The Relationship of 5-Aminolevulinic Acid on Mood and Coping Ability in Prediabetic Middle Aged and Older Adults.

In 2010, approximately 79 million Americans had prediabetes and about 50 percent of those individuals were 65 years and older. The most effective diabetes prevention method in prediabetic adults is lifestyle modification. However, despite the benefits of lifestyle change, diabetes prevalence continues to increase. Maintaining a regular exercise routine and a healthy eating plan may be difficult because of the negative emotional barriers (i.e., stress, mood) that a prediabetic individual faces. This is particularly evident in older individuals when you combine that with decreases in mobility and geriatric syndromes. A potential treatment for these emotional barriers is a natural supplement called 5-aminolevulinic acid (5-ALA). In the current study, the group included 154 participants, both men and women, ranging between the ages of 41 to 71 years old. The study design was a double-blind, randomized parallel-group study. The Psychosocial Depressive Symptoms Questionnaire (PDS) and the Perceived Stress Scale (PSS) were used to examine the effect of two doses of 5-ALA (15 mg and 50 mg) on various components of mood (i.e., hopefulness, loneliness, and motivation) and coping ability. Using SAS software, an ordered logistic regression model was used to analyze the association between the dose groups (control, 15 mg, and 50 mg) and the responses to the two questionnaires, the PDS and PSS, used in this study. An integrative literature review, using the PubMed database, searched for studies on the relationship between 5-ALA administration and mood and coping ability. Our literature review resulted in zero published articles. Next, we found that the intake of 5-ALA was significantly associated with improved coping ability (p = 0.004) and improved self-perception of effort spent (p = 0.002). Finally, we found a significant dose-dependent relationship for the association of 5-ALA intake on measures of effort (p = 0.003), loneliness (p = 0.006), and coping ability (p = 0.003). The 50 mg dose was more effective than the 15 mg dose in improving these measures. In conclusion, after 12 weeks of taking 5-ALA, we found significant improvements in self-perception of effort spent, loneliness, and coping ability in prediabetic middle age and older adults. Improved mood and coping ability may allow prediabetic individuals to overcome the emotional obstacles preventing them from maintaining a healthy lifestyle and ultimately, help them to avoid the development of diabetes.

Incorporating translational research with clinical research to increase effectiveness in healthcare for better health.

BACKGROUND: The transfer of new scientific discoveries into healthcare interventions requires that basic and clinical researchers work together with health care providers to generate team science. These innovative models require translational teams, and need to extend beyond the academic environment. The future of translational science requires partnerships with the healthcare community as well as the broader, general community. This new integrated model of effective translational teams holds promise for addressing thorny and persistent health disparities, is consistent with the nation's strategic priority of eliminating health disparities, and bodes well for increasing healthcare effectiveness aimed at better health for all. DISCUSSION: As part of the 13th Research Centers in Minority Institutions (RCMI) International Symposium on Health Disparities, several senior academic leaders joined efforts to hold a workshop to discuss a model that considers the incorporation of two translational research strategies in research career development programs: Comparative effectiveness research (CER) and community-based participatory research (CBPR) for increasing healthcare effectiveness and eliminating healthcare disparities. Discussion included what issues may be most germane to the concept of a unified model for research workforce development through formal training and career development leading to increased effectiveness in healthcare for better health. SUMMARY: We believe that there is a gap in knowledge and skills in formal research career development programs that will enable physicians, other clinicians, and basic scientists to actively participate in these two translational research strategies. The purpose of this paper is to share the outcomes of these discussions, and encourage further discussion and possible innovation in the formulation of a new model for translational research workforce development.

Recruitment and retention of under-represented groups with health disparities into clinical trials: a formative approach.

We evaluated the perceived success of recruitment and retention protocols for Native Hawaiian/Pacific Islander/Filipino populations. These three groups were found to have a significantly higher incidence of health disparities than the general population. Training applications of selected vignettes were also generated. Focus groups and questionnaires were used to achieve the objective: identification of themes related to facilitators and deterrents to participation in clinical trials in these populations. This mixed methods approach evaluated promotional materials preferred. Responses to animated videos and vignettes with actors regarding clinical research participation were analyzed. Participants included adults of Hawaiian/Pacific Islander or Filipino ethnicity. Analysis included grounded theory methods, such as constant comparative techniques. The results revealed that attention to the following categories is essential: culturally sensitive knowledge, attitudes, and beliefs related to individuals, families and communities. These themes are recommended as the structure for future interventions to improve participation and retention within these groups.

Evaluating the impact of a school-based prevention program on self-esteem, body image, and risky dieting attitudes and behaviors among Kaua'i youth.

Eating disorders and obesity (EDO) are increasing among youth, having serious long-term physical and psychological consequences. The purpose of this study was to determine if significant differences exist in EDO risk factors following participation of 4-6th grade students in a school-based EDO prevention curriculum. This community-based research project assessed students at baseline and one week following EDO intervention. Primary outcome variables measured self-esteem, body dissatisfaction, and high risk eating attitudes and behaviors. Pre and post-test differences were calculated using mixed models, correcting for clustering within schools and teachers. This study found mean changes in all scores in healthy directions, as well as movement of students into lower risk groups post-intervention. This program demonstrated that a classroom curriculum is associated with decreased risks of EDO in boys and girls, supporting prevention programs at an early age for both sexes. Studies to determine long term benefit and guide booster interventions are warranted.

Use of the dietary supplement 5-aminiolevulinic acid (5-ALA) and its relationship with glucose levels and hemoglobin A1C among individuals with prediabetes.

OBJECTIVE: This study examined the association between 5-aminolevulinic acid (5-ALA) and glucose tolerance. DESIGN: A double blinded, randomized prospective parallel-group comparison study. SETTING: Participants were recruited from the community in Honolulu, Hawaii, using radio and TV ads, and at community events. PARTICIPANTS: One hundred fifty-four males and females ages 40-70 years, with evidence of prediabetes: hemoglobin A1c (HbA1c) 5.8%-7.0% at the screening visit. INTERVENTION: Participants were randomized equally to one of three study groups: (1) low dose 5-ALA supplement (15 mg capsule); (2) high dose 5-ALA (50 mg capsule); and (3) control (placebo capsule of identical size and color). MAIN OUTCOME MEASURES: HbA1c and 2 hours post-oral glucose tolerance test (OGTT) glucose levels. RESULTS: Among individuals taking 5-ALA supplements for 12 weeks, 2 hours post-OGTT glucose levels declined significantly compared to those not taking the supplement (p= 0.02). The relationships were stronger among those with baseline glucose intolerance, or 2 hours post-OGTT glucose measurements greater than 140 mg/dL (p= 0.005 and p= 0.02 for the low and high dose group, respectively). Similar trends were observed for HbA1c but results were of borderline significance (p= 0.07). No untoward effects were reported. CONCLUSIONS: Further studies are indicated. The potential benefits of 5-ALA dietary supplementation are affirmed by this investigation.

Body Ideals and Body Dissatisfaction Among a Community Sample of Ethnically Diverse Adolescents on Kauai, Hawaii.

INTRODUCTION: Body dissatisfaction (BD), a risk factor for eating disorders, is occurring at younger ages and among a wide range of socioeconomic and cultural groups. OBJECTIVE: To describe body ideals and prevalence of body satisfaction among an ethnically diverse population of male and female students in Hawaii. METHODS: An anonymous cross-sectional survey including biographical information and the figure drawing screen was distributed to 7th through 12th grade students. RESULTS: Of the 1330 completed surveys, 19% of students were significantly dissatisfied with their bodies. Males were at greater risk than females for total BD (25.8% vs. 13.3%; p<0.001) and for BD in the direction of wanting to be larger (11.3% vs. 2.3%; p<0.001). Males and females were at similar risk for BD in the direction of wanting to be thinner (14.6% vs. 11.6%; p=0.11). Prevalence of BD in the direction of wanting to be thinner was significantly different (p<0.05) among ethnic groups. There were no significant differences in BD based on grade level or SES. CONCLUSIONS: BD exists among nearly 1 out of 5 adolescents, with differing patterns for males and females, and with certain ethnic groups being at higher risk. IMPLICATIONS: Studies to understand risk and protective factors by sex and among different ethnic groups may help generate tailored prevention strategies. Further research is needed to better understand the mechanisms underlying the bidirectional BD seen in males and potential outcomes.

A multiinstitutional, multidisciplinary model for developing and teaching translational research in health disparities.

Health disparities may affect any person in any community in the world, resulting from a multitude of factors including socioeconomic status, race, ethnicity, environment, and genetics. The impact of health disparities is felt by affected individuals, their families, communities, and the greater health care system. There is a critical need to increase health disparities research activities. This may be achieved by expanding and strengthening the training, education and career development of motivated clinicians, physicians and basic scientists, engaging them in clinical and translational research. Translational research relies on collaboration across disciplines, facilitating the dissemination and transfer of knowledge to populations for the overall improvement of health while decreasing the economic burden of health care. The University of Puerto Rico Medical Sciences Campus (UPR-MSC), Schools of Health Professions and Medicine joint initiatives, Clinical Research Education and Career Development (CRECD) and Hispanics in Research Capability (HiREC) programs, convened health disparities experts, faculty and scholars from multiple disciplines, cultural backgrounds and institutions. Together, they created a model for teaching translational research in health disparities that spans disciplines without boundaries.

Family history of later-onset breast cancer, breast healthy behavior and invasive breast cancer among postmenopausal women: a cohort study.

INTRODUCTION: A family history of later-onset breast cancer (FHLBC) may suggest multi-factorial inheritance of breast cancer risk, including unhealthy lifestyle behaviors that may be shared within families. We assessed whether adherence to lifestyle behaviors recommended for breast cancer prevention--including maintaining a healthful body weight, being physically active and limiting alcohol intake--modifies breast cancer risk attributed to FHLBC in postmenopausal women. METHODS: Breast cancer outcomes through August 2003 were analyzed in relationship to lifestyle and risk factors collected by questionnaire during enrollment (between 1993 and 1998) of 85,644 postmenopausal women into the Women's Health Initiative Observational Study. RESULTS: During a mean follow-up of 5.4 years, 1997 women were diagnosed with invasive breast cancer. The rate of invasive breast cancer among women with an FHLBC who participated in all three behaviors was 5.94 per 1,000 woman-years, compared with 6.97 per 1,000 woman-years among women who participated in none of the behaviors. The rate among women with no FHLBC who participated in all three behavioral conditions was 3.51 per 1,000 woman-years compared to 4.67 per 1,000 woman-years for those who participated in none. We did not observe a clinically important departure from additive effects (Interaction Contrast: 0.00014; 95% CI: -0.00359, 0.00388). CONCLUSIONS: Participating in breast healthy behaviours was beneficial to postmenopausal women and the degree of this benefit was the same for women with and without an FHLBC.

Translational leadership: new approaches to team development.

INTRODUCTION: Little is known about how to develop collaborative multidisciplinary research teams. METHODS: Following a comprehensive needs assessment, we developed a curriculum-based, multi-disciplinary, didactic and experiential Translational Leadership training program grounded in adult learning theory. In addition, we constructed collaborative clinical/translational research experiences for trainees to enhance clinical/translational research skills. KEY PROGRAMMATIC ELEMENTS AND PRELIMINARY FINDINGS: This 15-week Translational Leadership program was generated based on the following premises. Academic translational leadership teams should partner and collaborate, customize, make the program relevant to the culture, create a common language, use the best resources, and establish measurable goals for success. Development of effective collaborative research teams is essential to the management of successful translational research teams. Development of these skills in addition to cultural humility will provide the best infrastructure and human capital committed to the resolution of health disparities. Effective translational research teams are more comfortable with the component team members and the communities where they implement their protocols. Our participants highly valued the diverse experiences from this program; several have succeeded in leading community-based research teams. CONCLUSIONS: Our Translational Leadership program offers essential skills using adult learning theory for translational researchers who become capable of leading and participating in translational research teams. We believe including community members in the training of translational research programs is an important asset. The multidisciplinary approach develops skills that are also of significant use to the community and its acceptance of responsibility for its own health.

Changes in antidepressant medications prescribing trends in children and adolescents in Hawai'i following the FDA black box warning.

OBJECTIVES: To study prescribing trends for antidepressants in Hawai'i following the FDA black box warning regarding the possible risk of suicide in children and adolescents. We also explored relationships between changes in prescribing trends and patient and provider characteristics. STUDY DESIGN: Analysis of an existing insurance data set of prescriptions to children and adolescents within the State of Hawai'i. STUDY POPULATION: Children and adolescents under 18-years-old insured through the largest (>60%) third-party insurance company in the state. RESULTS: Our results showed variations in changes in prescribing trends for different selective serotonin reuptake inhibitors (SSRIs) following the FDA black box warning. SSRIs with more evidence-based research supporting their safety and efficacy were least affected as were those that were less implicated by the FDA analysis of the possible link between SSRIs and Suicidality. Trends were apparent for all age groups examined and for both females and males. CONCLUSIONS: Changes in prescribing patterns of psychiatric medications for children and adolescents in Hawai'i were identified. Differing patterns have evolved since 2003 following the series of concerns raised regarding SSRIs and suicidality in children and adolescents.

Factors associated with place of death for elderly Japanese-American men: the Honolulu Heart Program and Honolulu-Asia Aging Study.

Place of death is an indicator of health service utilization at the end of life and differs according to cause of death. Asian Americans may have a higher percentage of hospital deaths than Caucasian Americans, yet reasons for this finding are unclear. This study examined distribution of place of death and the associations between place and cause of death in elderly Japanese-American men in a longitudinal cohort: the Honolulu Heart Program and Honolulu-Asia Aging Study. Data collected between 1991 and 1999 on 1,352 men aged 73 to 99 at death were analyzed for associations between cause-of-death characteristics and hospital, home, or nursing home location of death. Fifty-nine percent of men died in hospitals, 23% died at home, and 18% died in nursing homes. Of the dementia-related deaths, 43% occurred in hospitals (vs 16% in a national study), 37% occurred in nursing homes (vs 67% in a national study), and 20% occurred at home. Of the stroke deaths, 53% occurred in hospitals, 40% were in nursing homes, and 7% occurred at home. Of the cancer deaths, 53% occurred in hospitals, 34% occurred at home, and 13% were in nursing homes. Traditional family obligation to care for elderly people at home and inability to access care for dementia may account for the greater rate of hospital death and lower rate of nursing home deaths in this cohort. Attitudes of elderly Japanese Americans and their families regarding place of care at the end of life, particularly in the setting of dementia, merit future study.

Novel polymorphisms of the amyloid precursor protein (APP) gene in Chinese/Taiwanese patients with Alzheimer's disease.

We aimed to determine if the amyloid precursor protein (APP) gene polymorphism is present in Chinese/Taiwanese patients with Alzheimer's disease (AD). This is a 3-year prospective assessment of the genotypes of the APP gene among Chinese/Taiwanese patients with AD. The sample consisted of 50 AD patients and 50 unaffected controls. Participants were recruited from the practices of the authors. Controls were comprised of 45 unrelated healthy subjects and 5 unaffected family members of AD patients. Data were collected in a university-based research unit of a tertiary medical center. Sequencing of the APP gene from exon 15 to exon 18 was performed on the peripheral blood of the patients and the unaffected controls after their informed consent was obtained. Among 50 AD subjects, 11 (7 men, 4 women) had APP gene polymorphisms. Mean age of onset was 72 years (range 65-82 years). Polymorphism of APP gene with A to C substitution at nucleotide position (nt) 284490 (A284490C) was found in 8 AD patients, at nt 284493 (A284493C) in 5, T284497C in 3 patients, and T284500C in 1 patient. These single nucleotide substitutions of the APP gene corresponded to the amino acid substitutions I718L, L720S, and V710G. These polymorphisms were not found in the unaffected controls. The mutations were confirmed by StyI restriction enzyme digestion assay using the subclone from polymerase chain reaction (PCR) products of the mutated APP gene. Thus, APP gene polymorphisms at codon 718 (I>L), 720 (L>S), and 710 (V>G) can be found in certain Chinese/Taiwanese patients with Alzheimer's disease.

Prevalence of breastfeeding among a multiethnic population in Hawaii.

INTRODUCTION: The purpose of this study, conducted in a multiethnic population in Hawaii, was to estimate the prevalence of breastfeeding at six months of age, exclusive and otherwise, as well as to identify positively and negatively associated factors. METHODS: A content-valid survey was conducted among a random stratified sample, and a printed questionnaire was sent to mothers of infants aged 7-10 months. A response rate of 70% yielded 701 completed surveys. RESULTS: At six months after birth, some breastfeeding was practiced by 54% of respondents. The rate of exclusive breastfeeding was approximately 16% at six months. Race and ethnicity assessment showed that Whites had the highest rates and Filipinos the lowest. Formula use in the hospital was most significantly associated with lower breastfeeding rates at six months. CONCLUSIONS: Exclusive breastfeeding for six months, even in a state with extremely high initiation rates, is seldom achieved. Formula use in the maternity units should be reduced, and intensive targeted study and education of the Filipino community should be undertaken.

Self identity through Ho'oponopono as adjunctive therapy for hypertension management.

OBJECTIVE: Self Identity through Ho'oponopono is a step-by-step problem-solving approach to identify and relieve stress. The objective of this study was to determine if Self Identity through Ho'oponopono along with standard medical therapy might better control hypertension than standard therapy alone. DESIGN, SETTING, PARTICIPANTS: Twenty-three Asian, Hawaiian, and other Pacific Islanders from a local community in Hawaii participated in a longitudinal design comparing pre- and post-intervention measures of blood pressure. INTERVENTION: Participants attended a half-day class on Self Identity through Ho'oponopono to learn ways to create balance and correct stress through an understanding of their own self identity. Participants learned processes to care for themselves through repentance, forgiveness, and transmutation and how to apply the processes in their daily lives. MAIN OUTCOME MEASURES: Repeated blood pressure measurements were compared before and after the intervention using generalized estimating equations; two spirituality questionnaires were administered before and after the intervention and analyzed with paired RESULTS: Systolic blood pressure decreased after the intervention, averaging 11.86 mm Hg below pre-intervention levels. Diastolic blood pressure decreased by 5.44 mm Hg. Spirituality scores significantly increased after the intervention. CONCLUSIONS: Self Identity through Ho'oponopono was associated with a statistically and clinically significant reduction in mean blood pressure. Spirituality scores increased after the intervention. We conclude that Self Identity through Ho'oponopono may be an effective adjunctive therapy for hypertension. Further research is needed to validate these preliminary findings.

Music and cancer pain management.

PROBLEM: When coupled with the often debilitating side-effects of pharmacological interventions, chronic cancer pain may elicit feelings of anxiety and depression and therefore adversely affect patient well-being and quality of life. PURPOSE: This review article is a systematic assessment of the published literature related to music and cancer pain management. METHOD: A comprehensive systematic evaluation of the data based literature was undertaken and analyzed using matrix analysis. RESULTS: As an adjunctive form of pain management, music therapy has been shown to address some of these hardships by providing patients with an alternative effective means by which to reduce their subjective experiences of pain. Studies investigating the efficacy of music therapy during invasive cancer procedures and chemotherapy demonstrated the role that attention states play in distracting patients from, and therefore minimizing their experience of, the pain associated with such treatments. Other studies examining diverse outpatient populations revealed similar findings, illustrating well the cognitive-affective dimensions of pain perception. Although these findings fail to adequately address the ambiguity surrounding music therapy's role in cancer pain management, music therapy has nonetheless been shown to significantly reduce anxiety and, in so doing, indirectly lessen the intensity of pain while improving patient quality of life.

Traumatic brain injury: outcomes from rural and urban locations over a 5-year period (Part 1).

The national death rates from rural trauma are disproportionately higher compared to urban areas. Traumatic brain injury is a major cause of hospital admissions in Hawai'i. This is the first in a two part series to explore this significant public health concern. Data on traumatic brain injuries from 2000-2004 was obtained from 2 sources. Male gender, alcohol use, and lack of protective devices resulted in higher rates of injury. Rates of severe injury were higher in young adults, the elderly, and in rural locations, but rural mortality rates here did not differ compared to urban settings. The greatest potential to reduce morbidity and mortality resides in the formulation and implementation of preventive strategies.

A collaborative approach to developing a validated competence-based curriculum for health professions students.

PROBLEM: Curricula are developed to educate health professions students to provide efficient and effective health services. In addition to learning their disciplinary perspective, today's students must master the concepts of multidisciplinary team care. Traditionally, curriculum was developed based primarily on the perspectives of the discipline faculty, administration and accrediting agencies. However, now there are multiple groups (other academic educators, consumers and employers of health care providers) who may hold differing perspectives about outcomes expected from these programs. PURPOSE: The purpose of this investigation was to use an innovative methodology to generate and validate a curriculum for health professions students from multiple disciplines. METHOD: A multi-phased method using focus groups, surveys, dissemination and affirmation was presented to identify the concepts and best practices that should be included. RESULTS: Several performance-based themes evolved during the interviews and a questionnaire was generated. Academic educators, consumers and employers of health care providers indicated agreement that the components on the survey were realistic and important for health professions students to achieve. Thus, outcomes for a curriculum were validated. The faculty rated several components of the curriculum as less realistic for students to achieve than did the consumers and employers. This investigation suggests it may be necessary for faculty to assist providers and parents in developing more realistic expectations about what students can achieve during their educational program. The approach used in this current project moves the field of the health professions curriculum development to a different level when compared with the traditional curriculum development approaches and should be used by others concerned with multi-professional education to assure the validity of the curricula.

A literature review on Complementary and Alternative Medicine for the treatment of breast cancer: Hawai'i.

The purpose of this literature review is to survey the scholarly work done in the field of Complementary and Alternative Medicine (CAM) as it relates to breast cancer treatment, accenting studies done on diverse ethnicities of Hawai'i. This study reviews articles published in biomedical literature from 1999-2005 that report findings related to the themes recognized in this area of study.

The use of Complementary and Alternative Medicine by Asian women of Hawai'i in the treatment of breast cancer.

This qualitative investigation examined complementary and alternative medicine (CAM) by Hawai'i Asian women breast cancer survivors. The majority of participants felt that the conventional treatment they received was adequate in treating their cancer but was impersonal in nature leaving them feeling abandoned. Many sought CAM to improve their quality of life. Additional research on CAM and the patient-physician relationship is urgently needed.