Consumers of natural health products: natural-born pharmacovigilantes?

<p>Abstract</p> <p>Background</p> <p>Natural health products (NHPs), such as herbal medicines and vitamins, are widely available over-the-counter and are often purchased by consumers without advice from a healthcare provider. This study examined how consumers respond when they believe they have experienced NHP-related adverse drug reactions (ADRs) in order to determine how to improve current safety monitoring strategies.</p> <p>Methods</p> <p>Qualitative semi-structured interviews were conducted with twelve consumers who had experienced a self-identified NHP-related ADR. Key emergent themes were identified and coded using content analysis techniques.</p> <p>Results</p> <p>Consumers were generally not comfortable enough with their conventional health care providers to discuss their NHP-related ADRs. Consumers reported being more comfortable discussing NHP-related ADRs with personnel from health food stores, friends or family with whom they had developed trusted relationships. No one reported their suspected ADR to Health Canada and most did not know this was possible.</p> <p>Conclusion</p> <p>Consumers generally did not report their suspected NHP-related ADRs to healthcare providers or to Health Canada. Passive reporting systems for collecting information on NHP-related ADRs cannot be effective if consumers who experience NHP-related ADRs do not report their experiences. Healthcare providers, health food store personnel, manufacturers and other stakeholders also need to take responsibility for reporting ADRs in order to improve current pharmacovigilance of NHPs.</p

Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System

<p>Abstract</p> <p>Background</p> <p>Mortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.</p> <p>Methods</p> <p>We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR) files.</p> <p>Results</p> <p>Using EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011). Similar declines were found for in-hospital and 90-day mortality.</p> <p>Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08).</p> <p>Conclusion</p> <p>Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.</p

Systematic screening for unsafe driving due to medical conditions: Still debatable

<p>Abstract</p> <p>Background</p> <p>Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective.</p> <p>Discussion</p> <p>Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided.</p> <p>Summary</p> <p>The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness) of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and evidence-based estimates of relevant indicators provides useful insight for further research.</p

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Hand dominance and side of stroke affect rehabilitation in chronic stroke

Objective: to examine the difference between upper extremity deficits in subjects with left versus right hemispheric lesions at baseline and after bilateral arm training.Design: a one-way ANOVA was used to detect group differences and a least square means analysis used to determine significance in pre-to-post scores for each group.Setting: testing was in the Physical Therapy and Rehabilitation Science Department Research Laboratory, University of Maryland, Baltimore. Training was at the Senior Exercise Rehabilitation Center in the Veterans Administration Hospital, Baltimore.Subjects: twenty-two (11 left hemispheric lesion, 11 right hemispheric lesion) right-handed subjects with chronic stroke.Interventions: a six-week nonprogressive repetitive bilateral arm training with rhythmic auditory cueing (BATRAC).Main measures: Fugl-Meyer Upper Extremity Test, Wolf Motor Arm Test, University of Maryland Arm Questionnaire for Stroke (UMAQS), isometric strength and active and passive range of motion for both sides.Results: no statistical differences were seen at baseline between groups in this sample. Both groups demonstrated improvement after BATRAC in Fugl-Meyer Upper Extremity Test (change scores of those with left lesions = 5.5; right lesions = 3.6) and UMAQS (change scores of those with left lesions = 5 and right lesions = 2.9). Additionally, patients with left hemispheric lesions but not right lesions made improvements in the Wolf Motor Arm Test (time and weight), in strength measures of paretic elbow flexion, shoulder extension, shoulder abduction and nonparetic wrist flexion, wrist extension and shoulder abduction.Conclusions: there were no baseline motor function differences between those with left and right hemispheric lesions in this sample. There was a clear training response advantage for patients with left hemispheric lesions after completing six weeks of bilateral arm training. As a result, treatment approaches for upper extremity hemiparesis may need to be more specifically selected based on side of strok

Fine motor control in adults with and without chronic hemiparesis: baseline comparison to nondisabled adults and effects of bilateral arm training

Objectives: to characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training.Design: nonrandomized controlled, cohort before-after trial.Setting: research institution.Participants: ten people from the community with chronic unilateral ischemic stroke and 10 age- and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm.Interventions: not applicable.Main outcome measures: measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate.Results: nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual paretic finger function, had slower and less consistent paretic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved paretic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions.Conclusions: in general, nonparetic finger control for tapping was preserved but paretic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after strok

Kinect-based individualized upper extremity rehabilitation is effective and feasible for individuals with stroke using a transition from clinic to home protocol

Purpose: To investigate the effectiveness and feasibility of Kinect-based upper extremity rehabilitation on functional performance in chronic stroke survivors. Methods: This was a single cohort pre-post test study. Participants (N = 10; mean age = 62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks in a university laboratory. To simulate a clinic to home transfer condition, individualized guidance was given to participants at the initial three sessions followed by independent usage. Outcomes included Fugl-Meyer assessment of upper extremity, Wolf Motor Function Test, Stroke Impact Scale, Confidence of Arm and Hand Movement and Active Range of Motion. Participant experience was assessed using a structured questionnaire and a semi-structured interview. Results. Improvement was found in Fugl-Meyer assessment scores (p = 0.001), Wolf Motor Function Test, (p = 0.008), Active Range of Motion (p < 0.05) and Stroke Impact Scale-Hand function (p = 0.016). Clinically important differences were found in Fugl-Meyer assessment scores (Δ = 5.70 ± 3.47) and Wolf Motor Function Test (Δ Time = −4.45 ± 6.02; ∆ Functional Ability Scores = 0.29 ± 0.31). All participants could use the system independently and recognized the importance of exercise individualization by the therapist. Conclusions. The Kinect-based UE rehabilitation provided clinically important functional improvements to our study participants

Exploiting interlimb coupling to improve paretic arm reaching performance in people with chronic stroke

Objective: to determine whether paretic arm reaching performance is improved in bilateral compared with unilateral conditions.Design: cohort study.Setting: university human performance laboratory.Participants: thirty-two subjects with chronic stroke (57±14y; on Fugl-Meyer Assessment arm score, 37±14).Intervention: unilateral and bilateral reaching. Bilateral tasks included varying levels of weight on the nonparetic hand.Main outcome measures: an electromagnetic tracking system recorded hand peak acceleration, velocity, and movement time. A 2-way repeated-measures analysis of variance and Tukey-adjusted pairwise comparisons were used to analyze the results (?=.05).Results: paretic differed significantly from nonparetic peak acceleration and velocity in unilateral reaching but not bilateral reaching. Within limbs, the paretic arm attained a higher peak acceleration (P&lt;.001) and velocity (P=.03) in the bilateral compared with the unilateral task, but movement time was unchanged between tasks. Nonparetic peak acceleration was higher (P=.015), velocity was unchanged, and movement time increased (P=.005) in the bilateral compared with the unilateral task. The addition of a weight to the nonparetic arm during bilateral reaching did not result in further improvement in paretic arm performance.Conclusions: interlimb coupling effects during bilateral reaching are retained even after chronic stroke and can be used to produce an immediate improvement in paretic arm reaching performance<br/

Intracortical inhibition and facilitation with unilateral dominant, unilateral nondominant and bilateral movement tasks in left- and right-handed adults

PurposeTo investigate intracortical inhibition and facilitation in response to unilateral dominant, nondominant and bilateral biceps activation and short-term upper extremity training in right- and left-handed adults.MethodsPaired-pulse transcranial magnetic stimulation was used to measure intracortical excitability in motor dominant and nondominant cortices of 26 nondisabled adults. Neural facilitation and inhibition were measured in each hemisphere during unilateral dominant, nondominant and bilateral arm activation and after training in each condition.ResultsNo differences were seen between right- and left-handed subjects. Intracortical facilitation and decreased inhibition were seen in each hemisphere with unilateral activation/training of contralateral muscles and bilateral muscle activation/training. Persistent intracortical inhibition was seen in each hemisphere with ipsilateral muscle activation/training. Inhibition was greater in the nondominant hemisphere during dominant hemisphere activation (dominant arm contraction).ConclusionStrongly dominant individuals show no difference in intracortical responses given handedness. Intracortical activity with unilateral and bilateral arm activation and short-term training differs based on hemispheric dominance, with the motor dominant hemisphere exerting a larger inhibitory influence over the nondominant hemisphere. Bilateral activation and training have a disinhibitory effect in both dominant and nondominant hemispheres