1,620 research outputs found
The Metabolic Syndrome and Mind-Body Therapies: A Systematic Review
The metabolic syndrome, affecting a substantial and increasing percentage of the worldwide population, is comprised of a cluster of symptoms associated with increased risk of type 2 diabetes, cardiovascular disease, and other chronic conditions. Mind-body modalities based on Eastern philosophy, such as yoga, tai chi, qigong, and meditation, have become increasingly popular worldwide. These complementary therapies have many reported benefits for improving symptoms and physiological measures associated with the metabolic syndrome. However, clinical trial data concerning the effectiveness of these practices on the syndrome as a whole have not been evaluated using a systematic and synthesizing approach. A systematic review was conducted to critically evaluate the data from clinical trials examining the efficacy of mind-body therapies as supportive care modalities for management of the metabolic syndrome. Three clinical trials addressing the use of mind-body therapies for management of the metabolic syndrome were identified. Findings from the studies reviewed support the potential clinical effectiveness of mind-body practices in improving indices of the metabolic syndrome
The metabolic syndrome and mind-body therapies: a systematic review,”
The metabolic syndrome, affecting a substantial and increasing percentage of the worldwide population, is comprised of a cluster of symptoms associated with increased risk of type 2 diabetes, cardiovascular disease, and other chronic conditions. Mindbody modalities based on Eastern philosophy, such as yoga, tai chi, qigong, and meditation, have become increasingly popular worldwide. These complementary therapies have many reported benefits for improving symptoms and physiological measures associated with the metabolic syndrome. However, clinical trial data concerning the effectiveness of these practices on the syndrome as a whole have not been evaluated using a systematic and synthesizing approach. A systematic review was conducted to critically evaluate the data from clinical trials examining the efficacy of mind-body therapies as supportive care modalities for management of the metabolic syndrome. Three clinical trials addressing the use of mind-body therapies for management of the metabolic syndrome were identified. Findings from the studies reviewed support the potential clinical effectiveness of mind-body practices in improving indices of the metabolic syndrome
Living in the epilepsy treatment gap in rural South India: A focused ethnography of women and problems associated with stigma
In India, women with epilepsy face unique challenges. A focused ethnography of six women within the epilepsy treatment gap was conducted in rural South India. Women were asked to describe their day-to-day lives. Data were collected through open-ended, semistructured interview questions, participant observation, and field notes. Thematic analysis was done. The disease-related stigma contributed to the women's physical, psychological, and emotional struggles; the women and their family members made every effort to conceal the disease. Educational interventions to create awareness could help women seek effective treatments for their seizures, thereby reducing the stigma and improving the quality of their lives
Women’s Experiences with Epilepsy Treatment in Southern India: A Focused Ethnography
Women with epilepsy in rural southern India often do not receive anti-epilepsy drugs (AEDs) or take these drugs regularly, but little is known about how they experience the epilepsy treatment they do receive. The purpose of this study was to provide an in-depth description of the treatment experiences of women in this region who had been diagnosed with epilepsy but who do not consistently take AEDs. Focused ethnography was conducted using participant observation and in-depth interviews with six women with epilepsy, eight of their family members, and two traditional healers. The women's treatment experiences are best described as living at the intersection of Western allopathic ("English") medicine and traditional healing practices-approaches that could be complementary or conflicting. The women revealed a variety of perceived barriers to the use of "English" medicine. Health care professionals should appreciate the dynamic interplay of the two treatment approaches and consider all cultural, social, and economic factors that influence the women's treatment experiences
Women’s Experiences with Epilepsy Treatment in Southern India: A Focused Ethnography
Women with epilepsy in rural southern India often do not receive anti-epilepsy drugs (AEDs) or take these drugs regularly, but little is known about how they experience the epilepsy treatment they do receive. The purpose of this study was to provide an in-depth description of the treatment experiences of women in this region who had been diagnosed with epilepsy but who do not consistently take AEDs. Focused ethnography was conducted using participant observation and in-depth interviews with six women with epilepsy, eight of their family members, and two traditional healers. The women’s treatment experiences are best described as living at the intersection of Western allopathic (“English”) medicine and traditional healing practices—approaches that could be complementary or conflicting. The women revealed a variety of perceived barriers to the use of “English” medicine. Health care professionals should appreciate the dynamic interplay of the two treatment approaches and consider all cultural, social, and economic factors that influence the women’s treatment experiences
Family Interactions Among African American Prostate Cancer Survivors
Prostate cancer affects African Americans at a higher rate than any other ethnic group in the United States. Prostate cancer does not only affect the man with the disease but also affects those individuals who are closest to him, such as his family and friends. Open communication is valuable in coping with stressors that are affiliated with chronic illnesses. This article focuses on family and friend social support of men with prostate cancer. Data analysis revealed that support from family members and friends plays an important role in how men cope with their treatment and recovery from prostate cancer. Originally published Family and Community Health, Vol. 31, No. 3, July-Sep 200
An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis
Background: Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the
human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in
placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence
than expected. We present the baseline characteristics of the PROUD study population and place the findings in
the context of national sexual health clinic data.
Methods: The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by
randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately
or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting
information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to
data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using
the genitourinary medicine clinic activity database (GUMCAD).
Results: The median age of participants was 35 (IQR: 29–43). Typically participants were white (81 %), educated at a
university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A
sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %)
and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %)
participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5–20) partners in the last 90 days,
a median (IQR) of 2 (1–5) were condomless sex acts where the participant was receptive and 2 (1–6) were condomless
where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the
past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees.
Conclusions: The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the
overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the
extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the
population interested in PrEP was highly selective.
Trial registration: Current Controlled TrialsISRCTN94465371. Date of registration: 28 February 2013
The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study
Background: Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint
effects, competing risk, or population subgroup differences.
Methods: We pooled data from seven prospective Australian cohort studies (n ¼ 367 058) and linked them to national
registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a
parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was
estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable
by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests
were two-sided.
Results: During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever
smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks
per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] ¼
19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, Pdifference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, Pdifference ¼ .047). We observed modification of
the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace.
Conclusions: We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed
novel differences between men and women, and other high–CRC burden subgroups that could potentially benefit most from
programs that support behavioral change and early detection.This work was supported by the Australian National Health and Medical Research Council (NHMRC; ID1060991). The Australian NHMRC also supported Dr. Laaksonen (ID1053642), Prof. Canfell (ID1082989), Prof. Banks (ID1042717), Prof. Shaw (ID1079438), and Prof. Magliano (ID1118161). Dr. Laaksonen was additionally supported by the Cancer Institute of New South Wales (ID13/ECF/1-07). Ms. Arriaga was supported by an Australian Postgraduate
Award and a Translational Cancer Research Network PhD Scholarship Top-up Award
Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD) : effectiveness results from the pilot phase of a pragmatic open-label randomised trial
Background Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. Methods PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). Findings We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64-96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3-11·3). 13 men (90% CI 9-23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. Interpretation In this high incidence population, daily tenofovir-emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. Funding MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences
A Large Linked Study to Evaluate the Future Burden of Cancer in Australia Attributable to Current Modifiable Behaviours
Introduction
The cancer burden preventable through modifications to risk factors can be quantified by calculating their population attributable fractions (PAFs). PAF estimates require large, prospective data to inform risk estimates and contemporary population-based prevalence data to inform the current exposure distributions, including among population subgroups.
Objectives and Approach
We provide estimates of the preventable future cancer burden in Australia using large linked datasets. We pooled data from seven Australian cohort studies (N=367,058) and linked them to national registries to identify cancers and deaths. We estimated the strength of the associations between behaviours and cancer risk using a proportional hazards model, adjusting for age, sex, study and other behaviours. Exposure prevalence was estimated from contemporary National Health Surveys. We harmonised risk factor data across the data sources, and calculated PAFs and their 95% confidence intervals using a novel method accounting for competing risk of death and risk factor interdependence.
Results
During the first 10-years follow-up, there were 3,471 incident colorectal cancers, 640 premenopausal and 2,632 postmenopausal breast cancers, 2,025 lung cancers and 22,078 deaths. The leading preventable causes were current smoking (53.7% of lung cancers), body fatness or BMI ≥ 25kg/m2 (11.1% of colorectal cancers, 10.9% of postmenopausal breast cancers), and regular alcohol consumption (12.2% of premenopausal breast cancers). Three in five lung cancers, but only one in four colorectal cancers and one in five breast cancers, were attributable to modifiable factors, when we also considered physical inactivity, dietary and hormonal factors. The burden attributable to modifiable factors was markedly higher in certain population subgroups, including men (colorectal, lung), people with risk factor clustering (colorectal, breast, lung), and individuals with low educational attainment (breast, lung).
Conclusion/Implications
Estimating PAFs for modifiable risk factors across cancers using contemporary exposure prevalence data can inform timely public health action to improve health and health equity. Testing PAF effect modification may identify population subgroups with the most to gain from programs that support behaviour change and early detection
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