Chronic Health Research Articles

Ramadan fasting in health and disease (2020): A narrative review

The medical literature on health aspects of Ramadan fasting (RF) is widely spread in many journals of varying access, making it less readily available to those interested in the subject. We performed a nonsystematic review of the international literature from a major online database (PubMed in 1 year [2020]). The search term “Ramadan fasting” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. The publications spanned fundamental, clinical, ethical, professional, cultural, and advocacy facets. The publications predictably crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the emerged themes depending on the retrieved literature. This year, the basic coverage included changes in physiology, nutrition during Ramadan. However, the clinical issues included a more comprehensive range such as the impact of RF on the liver and gut, and endocrine conditions such as hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease, maternal health and fetal well-being, cardiovascular medicine, nature and function of eyes, and neurological conditions, especially epilepsy. Sports medicine and athletes' well-being received somewhat prominent coverage. Other researchers focused on documenting patients' and health-care professionals' perceptions, attitudes, and practices during Ramadan. Health aspects of RF received a sustained academic interest with a broad spectrum in 2020. This narrative provides a scoping overview to help researchers and clinicians catch up quickly with state-of-the-art science today.

Взаимосвязь между уровнем тиреотропного гормона, инсулинорезистентностью и сердечно-сосудистыми факторами риска у пациентов с ожирением и субклиническим гипотиреозом

Актуальность. Эпидемия избыточного веса и ожирения представляет собой серьезную проблему для системы здравоохранения во всем мире и требует проведения профилактических мероприятий. Предполагаемые взаимо­связи между гормонами щитовидной железы, массой тела и гомеостазом жировой ткани находятся в центре внимания нескольких исследований в последние годы, однако причинно-следственные связи между этими параметрами четко не установлены. Цель: изучить взаимосвязь между уровнем тиреотропного гормона (ТТГ), инсулинорезистентностью (ИР) и факторами риска сердечно-сосудистых заболеваний в выборке лиц с ожирением и субклиническим гипотиреозом. Материалы и методы. Проведен ретроспективный продольный анализ 145 лиц с ожирением. Проанализированы уровни ТТГ и свободного тироксина (свT4), антропометрические измерения и результаты лабораторных тестов. Результаты. У 23 человек уровень ТТГ был выше нормы (субклинический гипотиреоз). Окружность талии (ОТ) у них была достоверно выше, чем у людей в состоянии эутиреоза. Уровень ТТГ в сыворотке положительно коррелировал с индексом инсулинорезистентности (HOMA-IR), содержанием триглицеридов и холестерина липопротеинов высокой плотности (ЛПВП). С использованием ТТГ и индекса массы тела в качестве независимых переменных было показано, что уровни ТТГ независимо связаны с HOMA-IR (p = 0,002) и содержанием триглицеридов (p = 0,006). Среди эутиреоидных пациентов лица со значениями ТТГ < 2,5 мМЕ/мл демонстрировали статистически значимое снижение соотношения ОТ и охвата бедер, уровня ЛПВП и показателей HOMA-IR, а также тенденцию к более низким значениям ОТ. Выводы. Субклинический гипотиреоз у людей с ожирением связан с избыточным наличием висцеральной жировой ткани. В настоящей выборке людей с ожирением уровни ТТГ связаны с инсулинорезистентностью.

A Machine Learning Approach to Predict Stress Hormones and Inflammatory Markers Using Illness Perception and Quality of Life in Breast Cancer Patients.

Psychosocial factors have become central concepts in oncology research. However, their role in the prognosis of the disease is not yet well established. Studies on this subject report contradictory findings. We examine if illness perception and quality of life reports measured at baseline could predict the stress hormones and inflammatory markers in breast cancer survivors, one year later. We use statistics and machine learning methods to analyze our data and find the best prediction model. Patients with stage I to III breast cancer (N = 70) were assessed twice, at baseline and one year later, and completed scales assessing quality of life and illness perception. Blood and urine samples were obtained to measure stress hormones (cortisol and adrenocorticotropic hormone (ACTH) and inflammatory markers (c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen). Family quality of life is a strong predictor for ACTH. Women who perceive their illness as being more chronic at baseline have higher ESR and fibrinogen values one year later. The artificial intelligence (AI) data analysis yields the highest prediction score of 81.2% for the ACTH stress hormone, and 70% for the inflammatory marker ESR. A chronic timeline, illness control, health and family quality of life were important features associated with the best predictive results.

Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities

BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted.MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library.ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health).ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.

A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial

BackgroundSpinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery.MethodsAdolescents 12–18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery.DiscussionDemonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery.Trial registrationNCT04637802 ClinicalTrials.gov. Registered on November 20, 2020

Using Smartphone Applications to Manage Chronic Conditions in Older Adults – A Review on Level of Evidence

Background: From health monitoring to health education and from behaviour change to falls sensing and health alerts to the simple pleasure of communication and connectedness, the mobile technologies (smartphone applications) are changing the lives of older adults.Objective: To examine current evidence of use of smartphones by older adults for health purposes (including communication, education, and health monitoring), and understand gaps and challenges in order to inform the design of future systems given the ubiquity of mobile phone technology.Methods: MEDLINE, CINAHL and Google scholar databases were searched from October 2016 to January 2017. Keywords used include ‘smartphone apps’, ‘mobile phone’, ‘chronic disease’, ‘chronic condition’, ‘older adults’ and ‘elderly’. A total of 12 articles were selected for quality assessment and grading of evidence.Results: Twelve different articles were found and categorized into nine different clinical domains with specific health related interventions. Articles were focused on diabetes care (2 articles), followed by COPD (2 articles), heart disease (1 article), Alzheimer’s/dementia Care (2 articles), osteoarthritis and pain management (1 article), fall prevention (1 article), colon cancer (1 article), palliative care (1 article), chronic kidney disease (1 article). Areas of interest studied included feasibility, acceptability, functionality and thereby determining their effectiveness. There were many different clinical domains; however, most of the studies were pilot studies. Current work in using mobile phones for older adult use are spread across a variety of clinical domains. Findings from different studies indicate that the use of mobile phone interventions has the potential to support successful management of chronic conditions and health behaviour change in older adults.Conclusion: Perceived benefits and willingness to use the smartphone apps are high; however, technical training and cost are main concerns. A common problem with elderly users was their reluctance to press buttons due to the fear of breaking something which has been resolved by touch screen technology of the smartphones. However, the advanced user clicked around the screen until he found what he was looking for, while the others spent a lot of time observing the screen and trying to determine the correct step. Promotion of user-friendly apps are expected especially for older adults having a diminished physical and cognitive abilities.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 381-387

Probabilistic health risk assessment of chlorpyrifos exposure among applicators on rice farms in Ghana.

Human health risk assessments of exposures to non-carcinogenic occupational and environmental toxicants have mostly been undertaken using the Hazard Quotient (HQ) approach, which largely ignores variabilities in both exposures and associated adverse health outcomes, unlike probabilistic approaches. Chlorpyrifos is a neurotoxic insecticide that is commonly applied by farmers in Ghana with limited research on associated health risks among applicators. The objective of this study was to assess health risks associated with chlorpyrifos exposure among applicators on rice farms in Ghana, using advanced probabilistic approaches that incorporate variability in both exposure doses and adverse response doses obtained from human epidemiological studies. Urine samples obtained from the applicators were analyzed for 3,5,6-trichloro-2-pyridinol (TCP)from which Absorbed Daily Dose (ADD) and Lifetime Average Daily Dose (LADD) levels of chlorpyrifos were estimated. The scientific literature was searched to identify human epidemiological data from studies that have reported chlorpyrifos adverse effects and their corresponding exposure levels. Equivalent ADD and LADD of chlorpyrifos were estimated from the human epidemiological data to obtain chlorpyrifos Toxicant Sensitivity Distributions (TSDs). Using the applicators' chlorpyrifos dose distribution and TSDs, adverse health risks among the applicators were characterized using the probabilistic approaches, Overall Risk Probability (ORP) and Monte Carlo Simulation (MCS). The probabilities of chlorpyrifos adverse health effects occurring under the chronic exposure scenarios ranged from 1 to 8%, while those for acute exposure scenarios ranged from 31 to 34%. This study indicates that while the risks of chronic adverse health effects from chlorpyrifos exposure among the applicators were low, acute health risks were high.

Distance learning: the “Extension for Community Healthcare Outcomes: ECHO” project: a case study

This article reports a case conference that was part of the Extension for Community Healthcare Outcomes (ECHO®) project, which is a model of monthly telemedicine conferences on chronic disease and behavioral health, important topics for primary care teams in rural areas and for university-based specialists. The ECHO® project has proved to be a successful learning model in health care. The main goal of the project is moving knowledge not the patients, so this tele-mentoring builds capacity and creates access to high-quality specialty care serving local communities. A secondary goal is shared learning between community providers and specialists about best practices that are practical, achievable, and sustainable for the community. We present the case of a critical care patient who was brought to the emergency department with left-side weakness and dysarthria. Computed tomography of the head and electrocardiograms established the diagnosis during the admission. Discussion points from a multidisciplinary team and specialty consultants via telemedicine are listed in this article.
 Key words: telemedicine, teleconsulting, primary care, developing countries, rural area

Psychotropic Medication Adherence in Children and Adolescents.

Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.

Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients.

In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival. Retrospective cohort study. Ten Dutch ICUs between January 2011 and April 2017. Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available. None. A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Δ48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]). An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.

A national pilot program for chronic diseases and health inequalities in South Korea

BackgroundTo achieve the health equity, it is important to reduce socioeconomic inequalities when managing chronic diseases. In South Korea, a pilot program for chronic diseases was implemented at the national level. This study aimed to examine its effect on socioeconomic inequalities in chronic disease management at the individual and regional levels.MethodsKorean National Health Insurance data from September 2016 to October 2017 were used. Study subjects in the national pilot program for chronic diseases included 31,765 participants and 5,741,922 non-participants. The dependent variable was continuity of prescription medication. Socioeconomic position indicators were health insurance contribution level and the area deprivation index. Covariates were gender, age, and the Charlson Comorbidity Index (CCI). A multilevel logistic regression model was used to address the effects at both the individual and regional levels. This is a cross-sectional study.ResultsUnlike the group of non-participants, the participants showed no inequality in prescription medication continuity according to individual-level socioeconomic position. However, continuity of prescription medication was higher among those in less deprived areas compared to those in more deprived areas in both the participation and non-participation groups.ConclusionsThis study found that the pilot program for chronic diseases at the least did not contribute to the worsening of health inequalities at the individual level in South Korea. However, there was a trend showing health inequalities based on the socioeconomic level of the area. These findings suggest that additional policy measures are needed to attain equality in the management of chronic diseases regardless of the regional socioeconomic position.

Health Analysis of Footballer Using Big Data and Deep Learning

With the development of information technology, health management and big data have risen and developed in recent years. Big data need proper analysis and shape in order to extract meaningful information from it. This paper analyzes the application status and prospects of big data in the field of health management. The results show that the most widely used big data in health management are intelligent wearable devices. Big data applications in football players’ mental health monitoring systems and chronic disease health management systems also have a good prospect. The intelligent wearable device is applied to several aspects of sports work: teaching and sports training, real-time monitoring of football players’ physical exercise process, collecting football players’ heart rate, calorie consumption, exercise steps, and track, blood pressure, blood oxygen, and other physical exercise data; through monitoring the heart rate, we can get the intensity and duration of football players’ physical exercise in school; through the calculation, we can also get the football players’ time energy consumption and understand the overall situation of football players’ physical exercise in school; through step counting and track monitoring, we can master the number of steps and track of football players; by monitoring the changes of blood oxygen and blood pressure of football players, we need to build a third-party residents’ health information storage and analysis system and further realize the marketization of residents’ health big data. The experimental results of the proposed study show the effectiveness of the proposed work.

A closed loop two cycle audit investigating the availability and accessibility of physical healthcare equipment on forensic inpatient wards within mersey care's secure division

AimsTo evaluate the provision of recommended medical equipment on forensic psychiatric inpatient wards in Mersey Care's secure division, as outlined by the Care Quality Commission (CQC) in their 2019 guidance “Brief Guide: Physical Healthcare In Mental Health Settings”. It has been documented that people with severe and enduring mental illness are at risk of dying on average 15 to 20 years earlier than people without, two thirds of which are due to avoidable physical illnesses. It was our aim to use these data to improve the provision of physical healthcare equipment on the wards of Mersey Care's secure division, in turn allowing for the safe assessment of patients in the acute setting, and the monitoring their chronic health conditions.MethodWe conducted a closed loop, two cycle audit of all forensic inpatient wards in Mersey Care's secure division measuring the provision of physical health equipment against the CQC's 2019 guidance. The intervention was to present our findings and implement physical health equipment boxes in the clinic rooms on the wards. Low, medium, high, and secure learning disability (LD) wards were audited, with a control sample of non-secure wards (addiction, old age, general adult, and LD non-secure) in the initial cycle for comparison.ResultOn initial audit, the mean availability of equipment across the secure division was 66% (range 50.9%-88.9%), and 75% across our sample of wards in the non-secure divisions (range 61.1%-88.9%). Following the intervention in the secure units, the mean availability increased to 73.5% (range 72.2%-77.8%). The mean percentage increase in equipment availability following intervention was 12.5% (range -12.5% to 41.8%).ConclusionFollowing the intervention, the re-audit conducted found an overall improvement with 73.5% of recommended equipment available. Despite this improvement in equipment availability in the secure unit wards, the equipment is still less available than on the non-secure control wards. Due to this, further intervention and another re-audit have been planned. In the second cycle, significant items such as disposable gloves, pulse oximeters, sphygmomanometers, thermometers and stethoscopes were available across all wards. This was an improvement from the initial audit and allows for the safe assessment of patients in the acute setting.

COVID-19: A Daily Dose of Yoga to Cope with Anxiety

: The coronavirus disease (COVID-19) pandemic has undoubtedly created unbearable psychological pressure on our minds such as anxiety, fear, worry, changing sleep patterns, changing eating patterns, worsening of existing chronic or mental health conditions, etc. There is an urgent need for the adoption of an effective coping strategy. We propose that yoga-based intervention may aid in improving mental and physical health with its multi-faceted dimensions.

52-LB: Weight Management Practices among U.S. Safety-Net Health Center Patients with Diabetes or Other Metabolic Disorders

Introduction: First-line intervention for the metabolic disorders or type 2 Diabetes is lifestyle change, including weight management, diet, and increased physical activity. This study evaluated the associations between health professional (HP) weight discussions and weight management practices among high risk safety-net patients. Methods: Cross-sectional data on adults (aged≥18 years) with self-reported diabetes, hypertension or hyperlipidemia from the 2014 National Health Center Patient Survey (HCPS) was analyzed. The HCPS is a nationally representative survey of patients receiving care at safety-net health centers. Outcome (binary) was whether patients tried to lose weight in prior 12 months. Independent variables were HP discussing the weight problem, talking about weight loss options (i.e., exercise), suggesting a nutritionist visit, or offering weight loss medication. Logistic regression models with complex sampling design was used to test the association between HP weight discussions and the outcome, adjusted for psycho-sociodemographic covariates. Results: Of 3671 patients, 55.5% (n=2039) tried to lose weight in prior 12 months. Women (62.4%) and Hispanic race/ethnicity (62.8%) were associated with a higher prevalence of attempting to lose weight in prior 12 months. In the fully adjusted model, having received HP’s weight discussion (AOR=5.54, 95%CI: 3.59-8.56), suggest exercise (AOR=3.61, 95% CI: 2.37-5.49), and recommend a nutritionist visit (AOR=2.59, 95% CI: 1.67-4.01) were associated for increased likelihood of attempting weight loss. Conclusions: HP advice to lose weight may increase patients’ motivation to lose weight and weight loss behavior. Better training for HPs in delivering high-value care such as brief weight counselling could lead to improved chronic disease health outcomes for safety-net patient populations. Disclosure J. J. Wang: None. Z. Shi: None. A. Yan: None.

Mammography screening disparities in Asian American women: Findings from the California Health Interview Survey 2015-2016.

e18568 Background: Foreign-born Asians were less likely to utilize preventive care due to medicine beliefs, language barriers, insurance coverage, and more. Their perceptions of breast cancer risks and screening benefits for asymptomatic conditions may differ from individuals born in the United States. It is urgent for preventive health professionals to understand screening disparities in Asian Americans. Methods: Data from the California Health Interview Survey (CHIS) 2015-2016 were used. Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening in relation to socioeconomic, chronic health condition/health behavior, and preventive care utilization, stratified by race. Results: Of NH-White and Asian American women aged 40 and above (unweighted N = 13,451), 78.41% were NH-White, 25.38% were foreign-born, 56.88% spoke only English at home, and 6.44% were not currently insured. The prevalence for self-reported mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. Among Asian American women, the lowest rate of mammograms was in Koreans (55.29%) and Chinese (72.19%) had the highest rate (p = 0.6438). In NH-White women, place of birth, smoking status, borderline diabetes, high blood pressure, is currently insured, and having a preventive care visit in the past 12 months were significant factors. Within Asian American women, borderline hypertension and having a preventive care visit were significant factors, but not ethnicity. Conclusions: The findings indicate that mammogram disparity in relation to socioeconomics, health behaviors, preventive care utilization, and race. Further development of ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should target Asian American women with borderline hypertension and no preventive care visits.

Attachment-Based Treatment of Chronic Medical Disorders: Learning from Stress-Based Mental Health Conditions

Adaptation to stressful conditions has been considered as a cause of chronic medical disorders for many years. However, the failure of adaptation involved in the genesis of these disorders has never been connected to mental health conditions that have the same adaptation failures to stress. A failure in the type of attachment in which parents help their children adapt to fearful conditions, which involves the hippocampus and amygdala regions in the brain, might be an underlying cause for both chronic medical disorders and mental health conditions. This paper will provide evidence for the underlying continuity of these conditions, as they relate to a similar type of attachment failure, as it impedes successful adaptation to stress. To demonstrate this continuity, case material is provided on patients with both conditions who are given model treatments that resolve each sequentially, indicating that they have a common attachment-based root. The importance of treating patients’ attachment-based deficits for both their medical and mental health issues concurrently supports using alternative, holistic medical strategies and attachment-based psychotherapy, in which the therapist can experience the fear of the patient and then advocate for them to help them resolve their problems for both types of conditions. The importance of using these therapies in treating chronic medical and mental health conditions is strongly supported by this evidence. These interventions are not adjunctive to the medical treatments but are as primary as the medical interventions in developing more pervasive resolution of the conditions.

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies.

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

Biopsychosocial factors and health outcomes associated with cannabis, opioids and benzodiazepines use among older veterans

ABSTRACT Background: Older Veterans may experience injuries that result in chronic pain and mental health conditions. Given the increasing availability of medical cannabis, it is important to examine if it serves as a viable or undesirable form of care relative to existing approaches. Objectives: We compared cannabis, prescription opioids, and benzodiazepines use between older Veteran and non-Veterans, and identified outcomes of cannabis use among Veterans. Because of the physical and mental conditions experienced by older Veterans we expected Veterans to report higher use of opioids and benzodiazepines compared to non-Veterans. Methods: We collected surveys from individuals aged 60 and older enrolled in the Illinois Medical Cannabis Patient Program and conducted logistic regression to identify factors associated with cannabis, opioids and benzodiazepines use between Veterans (N = 514, 90.2% male) and Non-Veterans (N = 2758, 41.1% male) across biopsychosocial factors. Results: Both groups reported similar levels of pain, quality of life, social satisfaction, and sleep quality. Veterans were more likely to use cannabis for mental health conditions (p = <.001) while they reported lower use for pain-related conditions (p = <.001) than non-Veterans. Veterans were less likely to use opioids (p = .013) and benzodiazepines (p < .01) compared to non-Veterans. Veterans also reported desirable health outcomes of cannabis use for pain, sleep quality, health conditions, and quality of life. Conclusions: Our work provides insights for clinicians and policy makers to consider whether cannabis can be a viable option to reduce or replace opioid and benzodiazepine use by older Veterans with chronic physical and mental health conditions.

Light-To-Moderate Raw Garlic Consumption Frequency Is Inversely Associated With Thickened Carotid Intima-Media Thickness: A Population-Based Study.

Background: Previous animal and clinical studies have reported beneficial effects of garlic preparations on carotid intima-media thickness (cIMT). However, no epidemiological study has yet investigated the association between dietary raw garlic consumption and cIMT in the general population. The objective of this study was investigating the association between dietary raw garlic consumption and thickened cIMT in Chinese adults.Methods: This cross-sectional study used data from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. A total of 4,329 general adults from 2015 to 2017 were included in this study. Frequency of consumption of raw garlic was summarized as four categories for analysis: < 1 time/week, 1 time/week, 2-3 times/week, ≥4 times/week with a validated food frequency questionnaire. The thickened cIMT was defined as common carotid artery IMT ≥ 1.0 mm or a carotid bifurcation IMT ≥ 1.2 mm by ultrasonography. Multivariable logistic regression analysis was used to examine the association between frequency of raw garlic consumption and thickened cIMT.Results: The prevalence of thickened cIMT is 22.9% among these participants. The adjusted odds ratios (95% confidence intervals) associated with the different frequencies were 1.00 (reference) for < 1 time/week, 0.74 (0.59, 0.94) for 1 time/week, 0.71 (0.55, 0.92) for 2–3 times/week, and 0.94 (0.71, 1.25) for ≥ 4 times/week.Conclusions: Light-to-moderate raw garlic consumption was inversely associated with thickened cIMT, whereas greater raw garlic consumption (i.e., ≥4 times/week) was not associated with thickened cIMT. Future longitudinal studies should be conducted to test these findings.