Complementary and Alternative Medicine's Effectiveness in Reducing High-Impact Chronic Pain and Opioid Consumption: A Case Report in the Veteran Population.

Chronic pain is a condition affecting millions of Americans annually. Veterans, as a population cohort, are often afflicted with chronic pain that is more complex, with higher rates of psychiatric and social comorbidities when compared to the general population. In this case report, we describe a veteran with major depressive disorder and alcohol abuse afflicted by high-impact chronic pain, initially treated and then maintained on high dose opioids developing dependency, who was successfully weaned off and achieved adequate pain management using complementary and alternative medicine, namely Qi gong. We conclude that complementary and alternative medicine offers a safe and effective option in providing pain relief using nonpharmacological means and thus avoiding undesired effects. We postulate that as research in this area increases, the demand for and the availability of complementary and alternative medicine will expand.

Cocoa-Rich Chocolate and Quality of Life in Postmenopausal Women: A Randomized Clinical Trial.

Menopause has a negative impact on quality of life (QoL). The aim of the present study was to analyse the effect on QoL of adding 10 g per day of chocolate with a high concentration of cocoa (99%) to the habitual diet, for 6 months, in a sample of postmenopausal women. Postmenopausal women (n = 140) aged 50-64 years were randomised to either an addition of 10 g per day of cocoa-rich chocolate to their usual diet or no supplement addition. All variables were measured at baseline and after six months of intervention. QoL was evaluated using the 3-level version of EuroQol-5D (EuroQoL-5D-3L), the EuroQol Visual Analogue Scale (EQ-VAS) and the Cervantes scale. Analysis of covariance (ANCOVA) analyses adjusted for the main determinants of QoL considered in this study showed no changes in the global score of QoL evaluated with the EuroQoL-5D-3L. The intervention group showed an increase of 6.0 points (95% confidence interval (CI): 0.4, 11.7) in the EQ-VAS compared to the control group (p = 0.036). No significant changes were observed between groups in the global score of QoL nor in the dimensions and subdimensions measured with the Cervantes scale. The additional daily contribution of 10 g of cocoa-rich chocolate in postmenopausal women could have a slight impact on their perception toward their health state, although without modifying the health-related QoL or the dimensions that compose it.

Opiniones de los y las profesionales de Atención Primaria sobre el consumo de alcohol en mujeres. Barreras percibidas para la intervención / Opinions of primary care professionals about alcohol consumption in women. Perceived barriers for intervention

Objetivo: conocer la opinión de los y las profesionales de Atención Primaria (AP) acerca del consumo de alcohol, especialmente entre las mujeres, analizar las dificultades encontradas e identificar áreas de mejora. Materiales y método: Se ha realizado una investigación cualitativa, entre el personal de AP de Salamanca. Fueron seleccionados profesionales (enfermería, medicina, pediatría, trabajo social y matronas) con más de dos años de experiencia en AP. Se desarrollaron 14 entrevistas y 4 grupos de discusión, cuyas grabaciones fueron transcritas obteniendo el texto base del análisis discursivo. Resultados: Los y las profesionales de AP reconocen una especial dificultad para detectar e intervenir frente a consumos de riesgo de alcohol y especialmente en el caso de las mujeres. Entre los factores contribuyentes se identifican, prejuicios y estereotipos de género, el temor a invadir la intimidad del paciente, la sobrecarga y organización del trabajo, y otros relacionados con las habilidades para realizar la detección y la intervención breve. Discusión: Se precisan actuaciones sensibilizadoras y formativas con perspectiva de género que faciliten al personal sanitario el abordaje de situaciones de consumo de riesgo de alcohol, sistematizar el consejo preventivo y orientarlo a la salud de las propias mujeres. También se perciben carencias en la coordinación de los recursos disponibles tanto preventivos como asistenciales

Objective: to find out the opinion of Primary Care (PC) professionals on alcohol consumption, particularly among women; to analyze the difficulties that are found in the process; and to identify areas which can be improved. Materials and method: A qualitative study was conducted among Salamanca PC professionals. Different professionals (from the fields of nursery, medicine, pediatrics, social work and midwifery) with more than two years of experience in PC were selected. In total, 14 interviews and 4 group discussion sessions were carried out, and the recordings were transcribed to obtain the text for discourse analysis. Results: PC professionals recognize that it is particularly difficult to detect and intervene in cases of risky consumption of alcohol, and especially in the case of women. Among the contributing factors, the following were mentioned: prejudices and gender stereotypes, fear of invading patients’ privacy, work overload, structure of work load, and other aspects related to the abilities to carry out detection and brief intervention. Discussion: A set of training and awareness-raising activities with a gender perspective is required in order to facilitate the management of situations of risky alcohol consumption for healthcare professionals, as well as to systematize preventive advice and orient it towards women’s health. Deficiencies were also observed in the coordination of available resources, both preventive and healthcare-related

Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review.

OBJECTIVE: To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. METHODS: Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. RESULTS: Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. CONCLUSION: Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.

Anatomical distribution of lipids in human brain cortex by imaging mass spectrometry.

Molecular mass images of tissues will be biased if differences in the physicochemical properties of the microenvironment affect the intensity of the spectra. To address this issue, we have performed-by means of MALDI-TOF mass spectrometry-imaging on slices and lipidomic analysis in extracts of frontal cortex, both from the same postmortem tissue samples of human brain. An external calibration was used to achieve a mass accuracy of 10 ppm (1σ) in the spectra of the extracts, although the final assignment was based on a comparison with previously reported species. The spectra recorded directly from tissue slices (imaging) show excellent s/n ratios, almost comparable to those obtained from the extracts. In addition, they retain the information about the anatomical distribution of the molecular species present in autopsied frozen tissue. Further comparison between the spectra from lipid extracts devoid of proteins and those recorded directly from the tissue unambiguously show that the differences in lipid composition between gray and white matter observed in the mass images are not an artifact due to microenvironmental influences of each anatomical area on the signal intensity, but real variations in the lipid composition.

Relative antithrombotic and antihemostatic effects of protein C activator versus low-molecular-weight heparin in primates.

The anticoagulant and anti-inflammatory enzyme, activated protein C (APC), naturally controls thrombosis without affecting hemostasis. We therefore evaluated whether the integrity of primary hemostasis was preserved during limited pharmacological antithrombotic protein C activator (PCA) treatment in baboons. The double-mutant thrombin (Trp215Ala/Glu217Ala) with less than 1% procoagulant activity was used as a relatively selective PCA and compared with systemic anticoagulation by APC and low-molecular-weight heparin (LMWH) at doses that inhibited fibrin deposition on thrombogenic segments of arteriovenous shunts. As expected, both systemic anticoagulants, APC (0.028 or 0.222 mg/kg for 70 minutes) and LMWH (0.325 to 2.6 mg/kg for 70 minutes), were antithrombotic and prolonged the template bleeding time. In contrast, PCA at doses (0.0021 to 0.0083 mg/kg for 70 minutes) that had antithrombotic effects comparable with LMWH did not demonstrably impair primary hemostasis. PCA bound to platelets and leukocytes, and accumulated in thrombi. APC infusion at higher circulating APC levels was less antithrombotic than PCA infusion at lower circulating APC levels. The observed dissociation of antithrombotic and antihemostatic effects during PCA infusion thus appeared to emulate the physiological regulation of intravascular blood coagulation (thrombosis) by the endogenous protein C system. Our data suggest that limited pharmacological protein C activation might exhibit considerable thrombosis specificity.

Actividad antiviral de la lactoferrina de calostro humano contra el virus Herpes simple tipo 1 / Antiviral activity of human colostral lactoferrin against herpes simplex virus type 1

En el presente trabajo se evaluan la citotoxidad y actividad de una preparación local de lactoferrina de calostro humano para determinar su inocuidad y la actividad bilógica. en el modelo VHS-1 /células Vero, sta preparación de lactoferrina mostró una actividad antiviral significativa contra VHS-1 con parámetros (CC50-54,3uM, ED50 1,4uM, SI-39) Similares a los reportados para otras preparaciones comerciales de lactoferrina humana. Esta preparación de lactoferrina inhibió la actividad hemaglutinante del VHS-1 en eritrocitos de ratón. Se muestra por primera vez, que la actividad antiviral de la lactoferrina y la heparina contra VHS-1 se anulan, si ambas sustancias se mezclan antes de la infección viral(AU)