Opioids for Dyspnea End of Life Review

Objective: The objective of this systematic review is to consolidate the existing evidence on opioid use, including administration, dosing and efficacy, for the relief of dyspnea at end-of-life. The overarching goal is to optimize clinical management of dyspnea by identifying patterns in opioid use, improving opioid management of dyspnea, and to prioritize future research. Background: Opioids are commonly used in the management of dyspnea at end of life; yet specific administration guidelines are limited. A greater understanding of the effectiveness of opioids in relieving end-of-life dyspnea with consideration of study design, patients, and opioids, including dyspnea evaluation tools and outcomes, will leverage development of standardized administration and dosing. Methods: A PRISMA guided systematic review using six databases identified quality studies of opioid management for patients with dyspnea at end of life. Results: Twenty-three references met review inclusion criteria which included terminally ill cancer and non-cancer patients with various diagnoses. Studies included two randomized controlled trials, three non-randomized experimental, three prospective observational, one cross-sectional, and one case series. Thirteen retrospective chart reviews were also included due to the limited rigorous studies rendered by the search. Thirteen studies evaluated morphine, followed by fentanyl (6), oxycodone (5), general opioid use (4), and hydromorphone (2). Routes of administration were parenteral, oral, combination, and nebulization. Dyspnea was evaluated using self-reporting and non-self-reporting evaluation tools. Sedation was the most reported opioid related adverse effect. Discussion: Challenges persist in conducting end of life research preventing consensus on standardization of opioid treatment for dyspnea within this specific palliative timeframe. Future robust prospective trials using specific, accurate assessment with re-assessment of dyspnea/respiratory distress, and consideration of opioid tolerance, polypharmacy, and comorbidities are require

Therapeutic Lifestyle Changes for Hypertension and Cardiovascular Risk Reduction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72505/1/j.1524-6175.2003.02179.x.pd

Acidic Polysaccharide Extracts from Gastrodia Rhizomes Suppress the Atherosclerosis Risk Index through Inhibition of the Serum Cholesterol Composition in Sprague Dawley Rats Fed a High-Fat Diet

Obesity is associated with a broad spectrum of cardio-metabolic disturbances, including atherosclerosis and cardiovascular disease (CDV). A high-fat diet has been shown to cause an elevation of the plasma cholesterol levels in humans, and the control of serum cholesterol has been demonstrated to be important in the prevention of CVD and atherosclerosis. The aims of this study were to demonstrate that crude and acidic polysaccharide extracts from Gastrodia rhizomes suppress atherosclerosis through the regulation of serum lipids in Sprague Dawley (SD) rats fed a high-fat diet. We examined the concentrations of serum lipids, including total cholesterol, triglycerides, high-density lipoproteins (HDL) cholesterol, and low-density lipoproteins (LDL) cholesterol, in SD rats fed a high-fat diet and evaluated the atherogenic index. Here, we show that both crude and acidic polysaccharide extracts from Gastrodia rhizomes inhibited the total cholesterol and LDL levels. Moreover, there was a significantly suppressed atherosclerosis risk due to the acidic polysaccharide extract from Gastrodia rhizome. Taken together, our results suggested that acidic polysaccharide extracts from Gastrodia rhizomes might be beneficial for lowering the incidence of CVD and atherosclerosis by reducing the de novo synthesis of total cholesterol and the LDL levels

Results of Go Girls: A Weight Control Program for Overweight African‐American Adolescent Females

Objective : Go Girls was a church‐based nutrition and physical activity program designed for overweight African‐American (AA) adolescent females. Research Methods and Procedures : Ten predominantly middle‐socioeconomic churches were randomized to either a high‐intensity (20 to 26 sessions) or moderate‐intensity (six sessions) culturally tailored behavioral group intervention delivered over 6 months. Each session included an experiential behavioral activity, ∼30 minutes of physical activity, and preparation and tasting of healthy foods. In the high‐intensity group, girls also received four to six telephone counseling calls. From the 10 churches, 123 girls completed baseline and 6‐month post‐test assessments. The primary outcome was BMI; secondary outcomes included waist and hip circumferences, percentage body fat estimated by bioimpedance, serum insulin, glucose, and lipids, and cardiovascular fitness at 6‐month follow‐up. Selected measures were also collected at 1‐year follow‐up. Results : At 6‐month follow‐up, the net difference between the high‐ and moderate‐intensity groups was 0.5 BMI units. This difference was not statistically significant ( p = 0.20). There were no significant group differences in secondary outcomes. Girls in the high‐intensity condition, however, who attended more than three‐quarters of the sessions had significantly lower BMI and percentage body fat relative to girls in the high‐intensity group who attended fewer sessions. Findings at 1‐year follow‐up mirrored those at 6 months. Discussion : We concluded that the intervention was not effective in reducing adiposity, although there were some positive findings among high attenders. Despite the null result, the intervention was generally well received by participants. Future interventions may require greater dose and a more structured dietary change program.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93768/1/oby.2005.212.pd

Risk of high blood pressure in salt workers working near salt milling plants: A cross-sectional and interventional study

BACKGROUND: Workers working close to salt milling plants may inhale salt particles floating in the air, leading to a rise in plasma sodium, which, in turn, may increase the blood pressure and the risk of hypertension. METHODS: To test the above hypothesis, occupational health check-up camps were organized near salt manufacturing units and all workers were invited for a free health examination. The workers who worked with dry salt in the vicinity of salt milling plants were defined as "non-brine workers," while those working in brine pans located far away from milling plants were defined as "brine workers." Blood pressure (BP) was measured during each clinical examination. In all, 474 non-brine workers and 284 brine workers were studied. RESULTS: Mean systolic blood pressure of non-brine workers (122.1 ± 13.3 mm Hg) was significantly higher than that of brine workers (118.8 ± 12.8 mm Hg, p < 0.01). Mean diastolic blood pressure of non-brine workers (71.5 ± 10.4 mm Hg) was significantly higher than that of brine workers (69.7 ± 9.4 mm Hg, p = 0.02). The prevalence of hypertension was significantly higher in non-brine workers (12.2%) than in brine workers (7.0%, p = 0.02). Nineteen salt workers were monitored while they used face masks and spectacles, for six days. Systolic, as well as diastolic, blood pressure of these workers began declining on the third day and continued to decline on the fourth day, but remained stationary up to the sixth day. The concentration of salt particles in the breathing zone of these workers was 376 mg/m(3 )air. CONCLUSION: Inhalation of salt particles in non-brine workers may be an occupational cause of increased blood pressure

Dietary intakes and food sources of fat and fatty acids in Guatemalan schoolchildren: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Consumption of healthy diets that contribute with adequate amounts of fat and fatty acids is needed for children. Among Guatemalan children, there is little information about fat intakes. Therefore, the present study sought to assess intakes of dietary fats and examine food sources of those fats in Guatemalan children.</p> <p>Methods</p> <p>The study subjects consisted of a convenience sample of 449 third- and fourth-grade schoolchildren (8-10 y), attending public or private schools in Quetzaltenango City, Guatemala. Dietary data was obtained by means of a single pictorial 24-h record.</p> <p>Results</p> <p>The percentages of total energy (%E) from total fat, saturated fat (SFA) and monounsaturated fat (MUFA) reached 29%E for total fat and 10%E for each SFA and MUFA, without gender differences. %E from fats in high vs. low-socio economic status (SES) children were significantly higher for boys, but not for girls, for total fat (p = 0.002) and SFA (p < 0.001). Large proportions of the children had low levels of intakes of some fatty acids (FA), particularly for n-3 FA, with >97% of all groups consuming less than 1%E from this fats. Fried eggs, sweet rolls, whole milk and cheese were main sources of total fat and, SFA. Whole milk and sweet bread were important sources of n-3 FA for high- and low-SES boys and girls, respectively. Fried plantain was the main source of n-3 FA for girls in the high-SES group. Fried fish, seafood soup, and shrimp, consumed only by boys in low amounts, were sources of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, which may explain the low intakes of these nutrients.</p> <p>Conclusions</p> <p>α-linolenic acid, EPA and DHA were the most limiting fatty acids in diets of Guatemalan schoolchildren, which could be partially explained by the low consumption of sources of these nutrients, particularly fish and seafood (for EPA and DHA). This population will benefit from a higher consumption of culturally acceptable foods that are rich in these limiting nutrients.</p