The Use of Herbal Remedies among Mothers of Young Children Living in the Central Appalachian Region

ntroduction. Women often use herbal remedies as a complement or alternative to traditional medicine. Guided by the Comprehensive Model of Information Seeking, this study examined use of herbal remedies among mothers of young children living in the Central Appalachian Region. Methods. A cross-sectional study was conducted among mothers of young children (). The outcome measure of interest was the use of any herbal remedy in the past six months. Two scales were developed to measure information seeking channels and to measure beliefs about the safety/efficacy of herbal remedies. Results. One-third reported using herbal remedies in the past six months, with fenugreek being the most common. Most reported using herbal remedies to increase breast milk production and to relieve cold/flu-like symptoms. Women scoring highest in information seeking channels were three times as likely to use herbal remedies. Women scoring highest in the beliefs about the safety/efficacy of herbal remedies were four times as likely to use herbal remedies. Conclusion. Herbal remedies are commonly used among women living in the Central Appalachian Region, a region with lower education and income level. Therefore, public health interventions about the types, safety, and efficacy of herbal remedies may improve health within this population

The effects of a workplace intervention on employees’ cortisol awakening response

Work-related stressors are known to adversely affect employees’ stress physiology, including the cortisol awakening response (CAR)–or the spike in cortisol levels shortly after people wake up that aids in mobilizing energy. A flat or blunted CAR has been linked to chronic stress and burnout. This daily diary study tested the effects of a workplace intervention on employed parents’ CAR. Specifically, we tested whether the effects of the intervention on CAR were moderated by the type of days (workday versus non-work day). Data came from 94 employed parents from an information technology firm who participated in the baseline and 12-month diurnal cortisol components of the Work, Family, and Health Study, a group-randomized field experiment. The workplace intervention was designed to reduce work-family conflict (WFC) and implemented after the baseline data collection. Diurnal salivary cortisol was collected on 4 days at both baseline and 12 months. Multilevel modeling revealed that the intervention significantly increased employees’ CAR at 12 months on non-workdays, but this was not evident on workdays or for employees in the usual practice condition. The results provide evidence that the intervention was effective in enhancing employees’ biological stress physiology particularly during opportunities for recovery that are more likely to occur on non-work days.National Institute on Aging (U01AG027669)Work, Family & Health Network (U01HD051217)Work, Family & Health Network (U01HD051218)Work, Family & Health Network (U01HD051256)Work, Family & Health Network (U01HD051276)U.S. Army Research Institute for the Behavioral and Social SciencesNational Institute for Occupational Safety and Health (U010H008788)Alfred P. Sloan Foundation (2004-12-4)William T. Grant Foundation (9844)National Institutes of Health (U.S.) (Penn State General Clinical Research Center. Grant M01-RR-10732

The HIV VACCINE: Learning from Failure and Building on Success

An effective vaccine for acquired immune deficiency syndrome (AIDS) has eluded researchers since the identification of the HIV virus. There are many challenges in developing an effective HIV vaccine, including the lack of knowledge regarding the immune response to the virus and its diverse nature. Ethical concerns further complicate research. A recent phase III trial was performed in Thailand and showed that a significant reduction in HIV infection is possible. Pharmacists need to stay informed of these important breakthroughs in AIDS research in order to provide quality health information to patients in their community. This paper aims to evaluate the past failures and successes as well as explore the recent advancements towards finding a vaccine for HIV. An estimated 33.4 million individuals worldwide are currently living with acquired immune deficiency syndrome (AIDS).1 According to the Centers for Disease Control and Prevention, approximately 56,300 new cases of Human immunodeficiency Virus (HIV) developed during 2006 in the United States alone.2 A cure for this disease has puzzled and eluded researchers since the identification of the HIV virus in 1983. However, hope is on the horizon with the advances in research that could eventually lead to an effective HIV-1 vaccine. As one of the most accessible health care providers, pharmacists need to stay informed on these important breakthroughs in HIV/AIDS research in order to provide quality health information to patients in their community

Wind Effects on Near- and Midfield Mixing in Tidally Pulsed River Plumes

River plumes transport and mix land-based tracers into the ocean. In tidally pulsed river plumes, wind effects have long been considered negligible in modulating interfacial mixing in the energetic nearfield region. This research tests the influence of variable, realistic winds on mixing in the interior plume. A numerical model of the Merrimack River plume-shelf system is utilized, with an application of the salinity variance approach employed to identify spatial and temporal variation in advection, straining, and dissipation (mixing) of vertical salinity variance (stratification). Results indicate that moderate wind stresses (∼0.5 Pa) with a northward component countering the downcoast rotation of the plume are most effective at decreasing stratification in the domain relative to other wind conditions. Northward winds advect plume and ambient shelf stratification offshore, allowing shelf water salinity to increase in the nearshore, which strengthens the density gradient at the plume base. Straining in the plume increases with winds enhancing offshore-directed surface velocities, leading to increased shear at the plume base. Increased straining and larger density gradients at the plume base enhance variance dissipation in the near- and midfield plume, and dissipation remains enhanced if the shelf is clear of residual stratification. The smaller spatial and temporal scales of the Merrimack plume allow the mechanisms to occur at tidal time scales in direct response to instantaneous winds. This is the first study to show tidal time scale wind-induced straining and advection as controlling factors on near- and midfield mixing rates in river plumes under realistic winds

Candida albicans Induces Arginine Biosynthetic Genes in Response to Host-Derived Reactive Oxygen Species

The interaction of Candida albicans with phagocytes of the host\u27s innate immune system is highly dynamic, and its outcome directly impacts the progression of infection. While the switch to hyphal growth within the macrophage is the most obvious physiological response, much of the genetic response reflects nutrient starvation: translational repression and induction of alternative carbon metabolism. Changes in amino acid metabolism are not seen, with the striking exception of arginine biosynthesis, which is upregulated in its entirety during coculture with macrophages. Using single-cell reporters, we showed here that arginine biosynthetic genes are induced specifically in phagocytosed cells. This induction is lower in magnitude than during arginine starvation in vitro and is driven not by an arginine deficiency within the phagocyte but instead by exposure to reactive oxygen species (ROS). Curiously, these genes are induced in a narrow window of sublethal ROS concentrations. C. albicans cells phagocytosed by primary macrophages deficient in the gp91phox subunit of the phagocyte oxidase do not express the ARG pathway, indicating that the induction is dependent on the phagocyte oxidative burst. C. albicans arg pathway mutants are retarded in germ tube and hypha formation within macrophages but are not notably more sensitive to ROS. We also find that the ARG pathway is regulated not by the general amino acid control response but by transcriptional regulators similar to the Saccharomyces cerevisiae ArgR complex. In summary, phagocytosis induces this single amino acid biosynthetic pathway in an ROS-dependent manner

Freshwater Composition and Connectivity of the Connecticut River Plume During Ambient Flood Tides

The Connecticut River plume interacts with the strong tidal currents of the ambient receiving waters in eastern Long Island Sound. The plume formed during ambient flood tides is studied as an example of tidal river plumes entering into energetic ambient tidal environments in estuaries or continental shelves. Conservative passive freshwater tracers within a high-resolution nested hydrodynamic model are applied to determine how source waters from different parts of the tidal cycle contribute to plume composition and interact with bounding plume fronts. The connection to source waters can be cut off only under low-discharge conditions, when tides reverse surface flow through the mouth after max ambient flood. Upstream plume extent is limited because ambient tidal currents arrest the opposing plume propagation, as the tidal internal Froude number exceeds one. The downstream extent of the tidal plume always is within 20 km from the mouth, which is less than twice the ambient tidal excursion. Freshwaters in the river during the preceding ambient ebb are the oldest found in the new flood plume. Connectivity with source waters and plume fronts exhibits a strong upstream-to- downstream asymmetry. The arrested upstream front has high connectivity, as all freshwaters exiting the mouth immediately interact with this boundary. The downstream plume front has the lowest overall connectivity, as interaction is limited to the oldest waters since younger interior waters do not overtake this front. The offshore front and inshore boundary exhibit a downstream progression from younger to older waters and decreasing overall connectivity with source waters. Plume-averaged freshwater tracer concentrations and variances both exhibit an initial growth period followed by a longer decay period for the remainder of the tidal period. The plume-averaged tracer variance is increased by mouth inputs, decreased by entrainment, and destroyed by internal mixing. Peak entrainment velocities for younger waters are higher than values for older waters, indicating stronger entrainment closer to the mouth. Entrainment and mixing time scales (1–4 h at max ambient flood) are both shorter than half a tidal period, indicating entrainment and mixing are vigorous enough to rapidly diminish tracer variance within the plume

Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis

BACKGROUND: The objective of this study was to characterize insulin use and examine factors associated with persistence to mealtime insulin among patients with type 2 diabetes (T2D) on stable basal insulin therapy initiating mealtime insulin therapy. METHODS: Insulin use among patients with T2D initiating mealtime insulin was investigated using Thomson Reuters MarketScan(® )research databases from July 2001 through September 2006. The first mealtime insulin claim preceded by 6 months with 2 claims for basal insulin was used as the index event. A total of 21 months of continuous health plan enrollment was required. Patients were required to have a second mealtime insulin claim during the 12-month follow-up period. Persistence measure 1 defined non-persistence as the presence of a 90-day gap in mealtime insulin claims, effective the date of the last claim prior to the gap. Persistence measure 2 required 1 claim per quarter to be persistent. Risk factors for non-persistence were assessed using logistic regression. RESULTS: Patients initiating mealtime insulin (n = 4752; 51% male, mean age = 60.3 years) primarily used vial/syringe (87%) and insulin analogs (60%). Patients filled a median of 2, 3, and 4 mealtime insulin claims at 3, 6, and 12 months, respectively, with a median time of 76 days between refills. According to measure 1, persistence to mealtime insulin was 40.7%, 30.2%, and 19.1% at 3, 6, and 12 months, respectively. Results for measure 2 were considerably higher: 74.3%, 55.3%, and 42.2% of patients were persistent at 3, 6, and 12 months, respectively. Initiating mealtime insulin with human insulin was a risk factor for non-persistence by both measures (OR < 0.80, p < 0.01). Additional predictors of non-persistence at 12 months included elderly age, increased insulin copayment, mental health comorbidity, and polypharmacy (p < 0.05 for all). CONCLUSIONS: Mealtime insulin use and persistence were both considerably lower than expected, and were significantly lower for human insulin compared to analogs

Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I–III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life