Podcasts about epidemiologic

ไลฟ์ #90: หลักฐานทางคลินิคและพยาธิวิทยา ที่สนับสนุน “The zero-LDL Hypothesis”วันจันทร์ 24 ก.พ. 2568เวลา 20.00 น.✅ จากหลักฐาน A consensus statement from the European Atherosclerosis Society Consensus Panel“Low-density Lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic. Epidemiologic, and clinical studies.ตีพิมพ์ใน European Heart Journal 24 April, 2017 ซึ่งรวบรวมการติดตามคนไข้ไป 20 million person years พบความสัมพันธ์เชิงเส้นตรงระหว่างระดับ LDL-Cholesterol กับ ความเสี่ยงของโรคหลอดเลือดหัวใจ ยิ่งลดระดับ LDL-Cholesterol ได้ต่ำเท่าไหร่ ความเสี่ยงของโรคหลอดเลือดหัวใจก็ลดลงเท่านั้น✅ ถึงแม้ว่าจะมีหลักฐานทางคลินิกที่สนับสนุนผลลัพธ์ของการลดระดับ LDL-C ในการป้องกันการเกิดโรคหลอดเลือดหัวใจมากแค่ไหนก็ตาม มันก็ยังคงน่าสนใจเป็นอย่างยิ่งที่จะศึกษาว่า การลดระดับ LDL-C ให้ต่ำอย่างยิ่งยวด มีผลกระทบต่อภาวะธำรงดุลของไขมันในเลือด (Lipid Homeostasis) หรือไม่

Dando sequência à série "Naruhodo Entrevista" de conversas descontraídas com cientistas brasileiras e brasileiros, chegou a vez da Médica, Doutora em Fisiopatologia em Clínica Médica e Livre Docência em Pneumologia, Suzana Tanni.Só vem!> OUÇA (90min 14s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*Suzana Erico Tanni possui graduação em Medicina pela Universidade Estadual Paulista Júlio de Mesquita Filho (1998), doutorado em Fisiopatologia em Clínica Médica [Botucatu] pela Universidade Estadual Paulista Júlio de Mesquita Filho (2008) e Livre Docente em Pneumologia pela Universidade Estadual Paulista Júlio de Mesquita Filho (2018). Atualmente é Professora Associada da Universidade Estadual Paulista Júlio de Mesquita Filho. Foi presidente da Sociedade Paulista de Pneumologia e Tisiologia (2022-2023). Coordenadora da Comissão de Epidemiologia e Pesquisa Clínica da Sociedade Brasileira de Pneumologia e Tisiologia, com responsabilidade na construção de guidelines nacionais de conteúdo respiratório.Desde 2010 atua como Docente do curso MECOR - Methods in Epidemiologic, Clinical and Operations Research da American Thoracic Society e da Associación Latino Americana do Thorax. Atualmente é Docente Líder do nível 2, para realização de manual de procedimento operacionais e plano de análise estatística.É Editora Associada do periódico Jornal Brasileiro de Pneumologia na área de Epidemiologia e DPOC, na Revista Médica Brasileira na área de pneumologia e da Frontiers Medicine-Respiratory Diseases. Atua como "Guest Editor" nos periódicos Frontiers in Case Report in Respiratory Diseases e Women in Science: Pulmonary Medicine 2023.Desde 2008, atua em Estudos Multicêntricos sobre Doenças Respiratórias. Faz parte do 4-Consortium for Clinical Characterization of COVID-19 By EHR (4CE) liderado por pesquisadores da Harvard Medical School, Boston, USATem experiência na área de Medicina, com ênfase em Pneumologia, atuando principalmente no seguinte tema: doenças pulmonares; doença pulmonar obstrutiva crônica, tabagismo e covid-19.Lattes: http://lattes.cnpq.br/4887507894734442*APOIE O NARUHODO PELA PLATAFORMA ORELO!Um aviso importantíssimo: o podcast Naruhodo agora está no Orelo: https://bit.ly/naruhodo-no-oreloE é por meio dessa plataforma de apoio aos criadores de conteúdo que você ajuda o Naruhodo a se manter no ar.Você escolhe um valor de contribuição mensal e tem acesso a conteúdos exclusivos, conteúdos antecipados e vantagens especiais.Além disso, você pode ter acesso ao nosso grupo fechado no Telegram, e conversar comigo, com o Altay e com outros apoiadores.E não é só isso: toda vez que você ouvir ou fizer download de um episódio pelo Orelo, vai também estar pingando uns trocadinhos para o nosso projeto.Então, baixe agora mesmo o app Orelo no endereço Orelo.CC ou na sua loja de aplicativos e ajude a fortalecer o conhecimento científico.https://bit.ly/naruhodo-no-orelo

Dr. Adela Cope breaks down pelvic inflammatory disease, tubo-ovarian abscess, ovarian torsion, ectopic pregnancy and more in this densely packed chapter of Always on EM. Tune in as Alex and Venk also try to figure out which one has the correct mental model of PID and who will ask the first stupid question.    CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   LEARN MORE ABOUT RESIDENCY: https://youtu.be/gCQ0zimhhhY?si=NpsyTruGM9N_UpVM https://college.mayo.edu/academics/residencies-and-fellowships/emergency-medicine-residency-minnesota/   REFERENCES: Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113 Rutz M, Boulger C. Early Pregnancy. Sonoguide - American College of Emergency Physicians. Accessed 8/20/2024 (https://www.acep.org/sonoguide/basic/early-pregnancy)  Rodgers SK, et al. A lexicon for first-trimester US: Society of radiologists in ultrasound consensus conference recommendations. Radiology. 2024; 312(2):e240122 Kreisel K, Flagg EW, Torrone E. Trends in pelic inflammatory disease emergnecy department visits, United STates, 2006-2013. Am J Obstet Gynecol 2018;218:117e1-e10 Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. JEM 2008. 34(4):429-433 Mohseni M, Simon LV, Sheele JM. Epidemiologic and clinical characteristics of tubo-ovarian abscess, hydrosalpinx, pyosalpinx, and oophoritis in emergency department patients. Cureus. 2020;12(11):e11647 CDC sexually transmitted infections treatment guidelines, 2021 - Pelvic Inflammatory Disease (PID) accessed 8-20-24 Linden JA. et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized tli. Annals of Emerg Med 2017(70):825-834 Stein JC, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A Meta-Analysis. Annals of Emerg Med. 2010;56:674-683 Robertson JJ, Long B, Koyfman A. Emergency Medicine Myths: Ectopic pregnancy, evaluation, risk factors, and presentation. JEM. 2017(53)6819-828 Brown J, Fleming R, Aristizabal J, Rocksolana G. Does pelvic exam in the emergency department add useful information? West J Emerg Med. 2011;12(2):208-212 Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37:78-87  

6-21-24 - Dr. Joe discusses two USDA epidemiologic documents about the H5N1 in cattle outbreak. Michigan Dairy Herd and Poultry Flock Case ReportNational Epidemilogic BriefMN Department of Health request for PPEUMN Extension NewsUSDA APHIS - WebsiteFDA Updates PageMN Board of Animal Health - WebsiteQuestions, comments, scathing rebuttals? -> themoosroom@umn.edu or call 612-624-3610 and leave us a message!Twitter -> @UMNmoosroom and @UMNFarmSafetyFacebook -> @UMNDairyYouTube -> UMN Beef and Dairy and UMN Farm Safety and HealthInstagram -> @UMNWCROCDairyExtension WebsiteAgriAmerica Podcast Directory

AABP Executive Director Dr. Fred Gingrich is joined by guest Dr. Sharif Aly, an epidemiologist at the Veterinary Medicine Teaching and Research Center in Tulare, Calif. Aly graduated from Cairo University and practiced in Egypt before coming to the United States for advanced studies in preventive medicine and epidemiology. His team developed and published the BRD 100 and BRD 10K studies to identify various risk factors for Bovine Respirator Disease (BRD) in dairy calves. Aly explains the incidence of BRD in calves and how it has failed to improve despite improvements in tools for detection and prevention. We review the risk of various areas on BRD including colostrum management, housing, season, environment and nutrition. He also discusses the role of on-farm diagnostics and the California and Wisconsin scoring systems that veterinarians can use with producers to manage BRD risk in dairy calves, including the BRD scoring system developed into an app for on-farm use. Links:CA BRD Risk Assessment Brochure (English)CA BRD Risk Assessment Brochure (Spanish)UC Davis Veterinary Medicine Teaching and Research Center website Epidemiology of bovine respiratory disease (BRD) in preweaned calves on California dairies: The BRD 10K studyS.A. Dubrovsky, A.L. Van Eenennaam, B.M. Karle, P.V. Rossitto, T.W. Lehenbauer, S.S. AlyJ Dairy Sci https://doi.org/10.3168/jds.2018-14774A novel risk assessment tool for bovine respiratory disease in preweaned dairy calvesG.U. Maier, W.J. Love, B.M. Karle, T.W. Lehenbauer, A.L. Van Eenennaam, S.S. AlyJ Dairy Sci https://doi.org/10.3168/jds.2019-17650    

In celebration of Head and Neck Cancer Awareness Month this April, Oncology Data Advisor Fellows Forum and Editorial Board Members Samuel Kareff, MD, MPH; Matthew Hadfield, DO; and Nagashree Seetharamu, MD, sat down to discuss the epidemiology of head and neck squamous cell carcinomas (HNSCC), the diagnostic and treatment process of HNSCC, including: –Epidemiologic trends –Geographic distribution –Approved screening methods –Novel treatment combinations –Side effects and adverse events –Survivorship –And more!

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Commentary by Dr Shin Huei Liu

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: August 3, 2017 The most common primary brain tumor that occurs in adults, glioblastoma multiforme, comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more about how to improve the survival and the quality of life of patients who suffer from this terrible illness. Produced by James E Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Gately L, McLachlan SA, Dowling A, Philip J. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv 2017;11(4):447-52. PMID 28194640Grady D. Glioblastoma, John Mccain's Form of Brain Cancer, Carries Troubling Prognosis. New York Times, July 20, 2017.Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016;131(6):803-20. PMID 27157931Scutti S. Sen John McCain has aggressive brain tumor, surgically removed. CNN, July 19, 2017.Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10(5):459-66. PMID 19269895Hegi ME, Diserens AC, Gorlia T, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005;352(10):997-1003. PMID 15758010Thakkar JP, Dolecek TA, Horbinski C, et al. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev 2014;23(10):1985-96. PMID 25053711Weller M, Wick W. Neuro-oncology in 2013: improving outcome in newly diagnosed malignant glioma. Nat Rev Neurol 2014;10(2):68-70. PMID 24419684  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Dr. Albright interviews Dr. Slaughter-Acey and Dr. Janevich about the appropriate use of race in epidemiologic research.  The full transcript and additional resources mentioned during that episode can be found at this link under handouts. 

"We just want people who menstruate to be able to do so safely and with dignity, and we don't think that's so big of an ask." In this episode, Dr. Allison Casola, Dr. Kierstin Luber, and Dr. Amy Henderson Riley discuss period poverty from an epidemiologic approach by considering three components: person, place, and time. They also identify policy opportunities, vulnerable populations, and the siloing of menstrual equity and reproductive education. The first step is increasing awareness, which is made easier by their glossary and other publications. This episode references the article titled "Period Poverty: an Epidemiologic and Biopsychosocial Analysis" by Allison R. Casola, PhD, MPH, MCHES, Kierstin Luber, DO, MPH, and Amy Henderson Riley, DrPH, MCHES. As mentioned in the episode, you can check out "No More Secrets" on Instagram at @nomoresecretsmbs, as well as Dr. Riley's book "Health Communication Fundamentals" at Springer Publishing or Amazon.

Bonjour et légaliser aus Mauritius! Nach unserem kleinen Ausflug in die öffentlich rechtlichen Medien mussten wir erstmal Urlaub machen. Aktuell befinden wir uns im indischen Ozean, aber haben natürlich nicht aufgehört zu recherchieren, dieses Mal zum Thema Cannabis. Wir beleuchten euch neben den Wirkstoffen THC und CBD auch ein wenig die Geschichte des Cannabis. Viele Jahrtausende als Allheilmittel genutzt und seit Anfang des 20. Jahrhunderts verboten, feiert Cannabis auch in der Medizin sein Comeback. Ob als Co-Analgetikum oder bei Spastiken, Cannabis findet viele Einsatzgebiete und die Verordnungen steigen seit 2017! Aber was ist eigentlich mit den Nebenwirkungen? Und was halten wir eigentlich davon? Und vergesst uns bitte nicht die Kinder! Schaltet auch diese Woche wieder ein und leistet uns Gesellschaft. Quellen: Batra, Bilke-Hentsch: Praxisbuch Sucht. Thieme 2016 Vergleich Wirkung CBD vs. THC https://www.cannamedical.com/wp-content/uploads/Vergleich-Wirkung-THC-CBD.web de Graaf et al.: Early cannabis use and estimated risk of later onset of depression spells: Epidemiologic evidence from the population-based World Health Organization World Mental Health Survey Initiative. In: American journal of epidemiology. Band 172, Nummer 2, 2010 Geschichte von Cannabis https://www.mwv-berlin.de/buecher-bestellen-2016/images/product_images/leseproben_images/ MDR Cannabis in der deutschen Geschichte https://www.mdr.de/geschichte/zeitgeschichte-gegenwart/politik-gesellschaft/cannabis-droge-54662913_Leseprobe.pdflegalisierung-100.html97839 BGM Cannabis Meldung https://www.bundesgesundheitsministerium.de/ministerium/meldungen/2017/maerz/cannabis-als-medizin-inkrafttreten Barmer FAQ Cannabis https://www.barmer.de/gesundheit-verstehen/medizin/cannabis/cannabis-faq-1124854#14_CBD_u2013_Wundermittel_oder_Abzocke-1124854 BGM Cannabis https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/c/cannabis#:~:text=Statistiken%20zum%20Cannabiskonsum&text=Bezogen%20auf%20alle%20jungen%20Erwachsenen,es%20noch%2012%2C7%20Prozent. Kommentar Richterbund Cannabis https://rsw.beck.de/aktuell/daily/meldung/detail/richterbund-bekraeftigt-kritik-an-cannabis-plaenen BKA Pressemitteilung Cannabis https://www.bka.de/DE/Presse/Listenseite_Pressemitteilungen/2022/Presse2022/221109_PM_Rauschgift.html Statist Verstöße mit Cannabis https://de.statista.com/statistik/daten/studie/702178/umfrage/polizeilich-erfasste-faelle-allgemeiner-verstoesse-mit-cannabis-in-deutschland/#:~:text=Im%20Jahr%202022%20wurden%20174.876,im%20Zusammenhang%20mit%20Cannabis%20ab. ZDF Jahresbericht UN https://www.zdf.de/nachrichten/politik/un-jahresbericht-drogen-gesundheitssysteme-cannabis-100.html#:~:text=Ein%20wachsender%20Anteil%20an%20psychischen,damit%20Psychosen%20wie%20Panikattacken%20auslösen. Marijuana addictive? https://nida.nih.gov/publications/research-reports/marijuana/marijuana-addictive Statist Cannabisabgabe GKV https://de.statista.com/statistik/daten/studie/1070486/umfrage/abgegebene-cannabis-einheiten-im-rahmen-der-gkv/#:~:text=Insgesamt%20wurden%202022%20im%20Rahmen,im%20Einzelfall%20medizinisches%20Cannabis%20verordnen. Algeacare https://www.algeacare.com/de-en/ CDC Marijuana Health effects https://www.cdc.gov/marijuana/health-effects/risk-of-other-drugs.html#:~:text=Researchers%20disagree%20on%20whether%20marijuana,drugs%2C%20like%20cocaine%20or%20heroin.&text=However%2C%20there%20is%20limited%20evidence,risk%20of%20using%20other%20drugs.

Dr. Carlos Mejia-Chew, an assistant professor in the Division of Infectious Disease at Washington University in St. Louis, and Sarah Gregory discuss spatial distribution of nontuberculous mycobacteria infections and risk factors in Missouri.

Gina improved IBS, anemia, joint pain, migraines, anxiety, mood, and brain fog on the carnivore diet. She is a 52-year-old dental hygienist and mother of three who has always been active and followed different diets throughout her life. She talks about her health struggles, including fatigue, numbness, and vision problems, which led her to undergo various tests and procedures, including a spinal tap. Gina also talks about her experience with a vegan diet, which she followed for 18 months. Initially, she felt better, but her health declined again later on. She experienced anemia, gallbladder surgery, and worsening IBS. While on the vegan diet, Gina tried to identify specific food sensitivities, but she couldn't pinpoint the cause of her issues. She also found the plant-based diet to be labor-intensive in terms of food preparation and admits that she was always hungry and eating a lot of volume.  Timestamps: 00:00 Trailer 00:47 Introduction 03:59 Starting to feel unhealthy in your forties 07:36 IBS, gall bladder removal 09:35 Eating a vegan diet 11:39 Cutting out junk food 13:26 Physicians discussing diet 16:34 Deciding to quit the vegan diet 20:26 Improvements on a carnivore diet 23:18 A day of eating on the carnivore diet 25:53 Epidemiologic studies 29:26 Vegan friend 31:44 Dental hygiene on the carnivore diet 35:48 Mastering diabetes 40:20 Long-term vegan health 44:10 Reintroducing foods 47:50 Pushback on switching from vegan to carnivore diet 51:33 Differences in hair, skin, and nails See open positions at Revero: https://jobs.lever.co/Revero/ Join Carnivore Diet for a free 30 day trial: https://carnivore.diet/join/ Book a Carnivore Coach: https://carnivore.diet/book-a-coach/ Carnivore Shirts: https://merch.carnivore.diet Subscribe to our Newsletter: https://carnivore.diet/subscribe/ . ‪#revero #shawnbaker #Carnivorediet #MeatHeals #HealthCreation   #humanfood #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree  ‪

Want to let us at the OCSHP Podcast know how we're doing and enter to win a $25 Amazon gift card? Follow this link to our survey on the Podcast's impact! - https://mbku.az1.qualtrics.com/jfe/form/SV_bEGaXq3nO0wjVbM . Survey will close and gift card winners will be drawn in April 2023. Monkeypox is a viral zoonotic infection that can spread from person to person. In May 2022, a new outbreak of monkeypox was reported in Europe. Cases were then reported in the United States an across the globe, with the World Health Organization eventually declaring the outbreak a public health emergency. Join us and guest experts Dr. Miriam Morkos, Pharm.D., BS; Dr. Lee Nguyen, Pharm.D., APh, BCPS, BCIDP; and Jenny Nguyen in this episode as we discuss monkeypox diagnosis, treatment, and other important points for healthcare providers! Interested in joining the Orange County Society of Health-System Pharmacists? Join us at https://ocshp.com/join-us/ ! Interested in appearing on the podcast? Let us know by emailing leadership@ocshp.com. *Please note that Monkeypox is an evolving situation. Epidemiologic data is reflective of when this episode was recorded in late 2022.

In part 1 I talked about information that was brought to me by two senior residents who wanted people to know that they are being invited to “educational summits” that are actually being run by doctors with massive undisclosed ties to the pharmaceutical companies that make the drugs that are recommended in the summits. I did some digging around the company that is behind this to try to get some information about what's going on.The company that created both of these summits is PCMG, Primary Care Metabolic Group. Their tagline is “Serving to Educate Primary Care Clinicians on Metabolic Issues.” The words “Evidence Based Medicine” appear prominently in the banner at the top of each page. Their homepage states:The Primary Care Metabolic Group (PCMG) is a national educational initiative providing comprehensive metabolic disease resources. PCMG's mission is to provide an easily accessible repository of metabolic disease information for primary care clinicians that includes disease management and raising standards of patient care through the dissemination of best practices and educational information.Their ”services” include·         Monthly metabolic disease news articles from our partners·         Opportunities for FREE CME·         Member discounts for upcoming CME conferences and summitsAs a quick aside, CME stands for Continuing Medical Education. Doctors must obtain a certain number of CMEs in order to maintain their state licensure. The number of CME hours and requirements as to topics varies by state.  Full disclosure, many of the workshops/talks I give for physicians provide CMEs. None, as far as I know, has ever been sponsored by a pharmaceutical company and I don't receive any money from the pharmaceutical industry.Back to PCMG. The word “partners” struck me in the first bullet point. What do they mean by “partners?” As I scrolled down the page I see that they are welcoming a new “collaborator” – the Ob*sity Action Coalition. It says “This national nonprofit coalition is fighting to eliminate weight bias and discrimination, elevating the conversation of weight and its impacts on health, and offering a community of support to people affected. OAC also offers resources for clinicians, as well as a database of clinicians who treat patients with ob*sity.”It doesn't say that this “national nonprofit coalition” has Novo Nordisk (manufacturer of the weight loss drug Wegovy and one of the leading pharma companies price gouging on insulin) as its main funder, with the vast majority of its funding coming from pharmaceutical companies and weight loss surgery interests. It doesn't say that their plan to “eliminate weight bias” is focused on pushing for insurance coverage of their dangerous drugs and surgeries, or that they are trying to sell the “we don't want to stigmatize fat people, we just want to make as much money as we can trying to eradicate them from the earth” line that is not, in any way, an anti-stigma approach.After reading the entire website, I called PCMG to ask what they meant by “partners” as well as who was funding the free and discounted CME training.I spoke with Nora Williams. I opened by explaining that I was writing an article about CME trainings and I had a couple quick questions about how their trainings were structured. She interrupted me to say that she was “suspicious” because she didn't know who I was, or what outlet I was writing for, or what my story was about (in my defense, she hadn't let me get that far.) She told me that if I sent her an email she would “consider it.” For me, this has the ring of a company that knows they are involved in things that they would rather not have brought to light, but of course, that's just my gut feeling. I emailed her after our call in the afternoon of 1/7/23 and am still awaiting a response.However, the email that she gave me led me to PCEConsortium.orgIn searching, I had already found Primary Care Respiratory Group – US (PCRG) which has a website that is almost an exact copy of PCMG, except replacing metabolic with respiratory. The Consortium site has a long list of free CME workshops.I wanted to look into their materials, so I started by downloading their free CME “Common Questions on Continuous Glucose Monitoring (CGM) in Primary Care” I am not an expert in CGM, but I do a lot of work around weight-neutral blood sugar management and so it's an area where I felt confident that I had enough knowledge to understand the paper.The author is Eden Miller, DO (who you may recognize as having been a speaker at both the free summits and having taken $1,429,227.40 in industry payments.) Miller is the co-founder and CEO of Diabetes Nation - Diabetes and Ob*sity Care, and in this publication disclosed that she serves on the advisory board and speakers bureau for Abbott Diabetes, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk; on the advisory board for AstraZeneca, Merck, Plenity, and Sanofi Aventis; and does research for Abbott Diabetes and Pendulum Pharmaceuticals.Here are some things that I noticed:Two of the devices that the paper specifically mentions are made by Abbot Laboratories (for whom Miller is a speakers bureau member and does research.)In the section “Which patients will benefit from its use” Miller (who, again, takes money from a CGM device manufacturer) writes “This author does not feel there are any poor candidates for CGM as all people with diabetes could benefit on some level from the data and insight it provides.”That struck me as odd. Again, I'm not an expert but it would be…surprising… if this device wasn't contraindicated for anyone. A quick search of Abbott's website (remember this is a company for which Dr. Miller does research and is on the speakers bureau) explains that you “should not use the [CGM] system” for people less than 18 years of age, critically ill patients, pregnant women or patients on dialysis,  and that the system has not been evaluated on patients who use other implanted devices. Other studies and articles mention things like technology aversion, medications that interfere with CGM, certain mental health diagnoses, patient motivation, and other contraindications.So, there are, in fact, poor candidates for CGM. I would suggest that this is a problem whether Dr. Miller was ignorant of this or purposely left it out. Remember, this is Continuing Medical Education – doctors are supposed to be able to rely on this information in their practice, so telling them that there aren't any poor candidates, when there very much are is a failure of that education and a danger to patients.There is a section for “Key elements to obtaining Medicare, Medicaid and private insurance,” complete with billing codes. It also mentions that “In a recent comparison of retail costs, Abbott's FreeStyle Libre had the lowest monthly cost…”The conclusion states “CGM is quickly emerging as a standard of care for many patients with diabetes.”To back this statement up, Miller cites a study by John B. Welsh, PhD and Roy Thomas, PharmD. A quick look at the disclosures for that study finds that both are employees of Dexcom, the manufacturer of the Dexcom G6 Continuous Glucose Monitor.You have to wonder: To what extent is this CME providing evidence-based information, and to what extent is this simply an extension of Dr. Miller's duties as a member of Abbott's Speakers Bureau?But maybe this one was just a fluke, right? While I was waiting on the reply from Nora that never came, I took a quick look at some of the other free CME on the consortium's page. I definitely found a pattern of CME that was recommending products that were part of the author's disclosures. A couple of quick examples:Title: Improving Detection and Management of Anemia in CKDAuthors: Steven Fishbane, MD; Stephen Brunton, MD, FAAFPDisclosures: Dr. Fishbane: Consultant and does research for Akebia and AstraZenec aand is a consultant for FibroGen and GlaxoSmithKline.Dr. Brunton:  Advisory board and speakers bureau for Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, and Sanofi, and on the advisory board for Xeris and Pendulum Therapeutics.Summary: “HIF-PHIs are investigational agents on the horizon that, if approved, will offer patients an oral option to treat anemia in CKD”A quick search found that AstraZeneca, GlaxoSmithKline, and Akebia are all developing HIF-PHIs.Title: The Role of Eggs in Healthy DietsAuthor: Maria Luz Fernandez, PhDKey takeaways: Eggs can be part of a healthy diet, Epidemiologic evidence and clinical trials have found no links between egg intake and increased risk for heart disease, Eggs are a good source of high-quality protein, Eggs, in addition to numerous vitamins and minerals, contain compounds including choline, lutein, and zeaxanthin with functions that go beyond nutrition as they protect against chronic disease.Disclosure: Dr. Fernandez has a research grant from The American Egg Board.Sponsorship: “This [CME] activity is sponsored by Primary Care Education Consortium and supported by funding from The American Egg Board.”There is language in some of PCMG's CMEs (though, interestingly, not in the egg-related CME) that claims that conflicts of interest have been “mitigated,” but is that even truly possible?Regardless of how ethical the authors might be, there are undeniable conflicts of interest when those who are creating education about pharmaceuticals are also paid advocates for those pharmaceutical companies.At some point, simply disclosing affiliations is not enough. I believe that we are, in fact, way past that point. There is literally nothing to prevent the pharmaceutical industry (not to mention weight loss surgery interests, medical device manufacturers, etc.) from simply putting a stable of doctors on their payroll and letting them use their credentials as the ultimate sales tools, including by engaging with companies that convert pharmaceutical industry marketing messages into CMEs that are delivered to doctors and other healthcare practitioners who think that they are getting education about best practices and educational information. It's similar to what we've seen in the media and it is a dangerous disservice to healthcare practitioners and patients.I want to, again, give thanks and credit to Dr. Clarissa O'Conor and Dr. Will Ward, who originally reached out to me, for all of the work they did researching this. They are in the middle of intense training and still finding the time to do extra work to try to get the education (free from pharma industry influence,) that they deserve.And we should all have their backs - asking questions, doing research, pointing out these flagrant conflicts of interest and dirty diet industry tactics. Our doctors deserve the best education they can get, not the best education pharmaceutical companies can buy.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.Note I don't link to everything I discuss in this post because I don't want to give traffic and clicks to dangerous media. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Welcome to the podcast with Dr. Brendan McCarthy! In this episode we go over, why are testosterone levels decreasing? and what can we do moving forward? This is part 1 of a 3 part series. Dr. Brendan McCarthy founded Protea Medical Center in 2002. While he's been the chief medical officer, Protea has grown and evolved into a dynamic medical center serving the Valley and Central Arizona. A nationally recognized as an expert in hormone replacement therapy, Dr McCarthy s the only instructor in the nation who teaches BioHRT on live patients. Physicians travel to Arizona to take his course and integrate it into their own practices. Besides hormone replacement therapy, Dr. McCarthy has spoken nationally and locally before physicians on topics such as weight loss, infertility, nutritional therapy and more. Thank you for tuning in and don't forget to hit that SUBSCRIBE button! Let us know in the COMMENTS if you have any questions or what you may want Dr. McCarthy to talk about next! Check out Dr. Brendan McCarthy's Book! https://www.amazon.com/Jump-Off-Mood-Swing-Hormones/dp/0999649604 --More Links-- Instagram: www.instagram.com/drbrendanmccarthy TikTok: www.tiktok.com/drbrendanmccarthy Clinic Website: www.protealife.com Cited Links: 7:00 & 8:32 • Elliott, Christopher S., et al. "Epidemiologic trends in penile anomalies and hypospadias in the state of California, 1985–2006." Journal of pediatric urology 7.3 (2011): 294-298. • Nelson CP, Park JM, Wan J, et al. The increasing incidence ofcongenital penile anomalies in the United States. J Urol 2005;174:1573e6 • Nassar N, Bower C, Barker A. Increasing prevalence of hypospadias in Western Australia, 1980e2000. Arch Dis Child 2007;92:580e4 • Aho M, Koivisto AM, Tammela TL, et al. Is the incidence of hypospadias increasing? analysis of Finnish hospital discharge data 1970e1994. Environ Health Perspect 2000;108:463e5 12:30 - Snyder PJ, Peachey H, Hannoush P, et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab. 1999;84[8]:2647-2653 14:06 - Azad et al., 2003. Azad N, Pitale S, Barnes WE, Friedman N: Testosterone treatment enhances regional brain perfusion in hypogonadal men. J Clin Endocrinol Metab 2003; 88:3064-3068. 30:12 - Layton JB, Li D, Meier CR, et al. Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. J Clin Endocrinol Metab. 2014;99(3):835-842 - Layton JB, Kim Y, Alexander GC, Emery SL. Association Between Direct-toConsumer Advertising and Testosterone Testing and Initiation in the United States, 2009-2013. JAMA. 2017;317(11):1159–1166. doi:10.1001/jama.2016.21041   #lowtestosterone #testosterone #menshealth #erectiledysfunction #libido #testosteronebooster #testosteronereplacementtherapy #testosteronetherapy #hormonereplacementtherapy

The aim (focus) of this poster is to consider digital transformations of Analog Geography Hunting Grounds Maps (AGHGMs) (image 1) as well opportunities of introduce digital hunting grounds maps (DHGMs) in veterinary surveillance, monitoring, control programme for wildlife populations. Geographical Information System (GIS) as a computer based analyzing system displaying digital data with spatial sets. Spatial veterinary epidemiology (SVE) enabled the spatial/location of TADs and FAST diseases to aim identify the susceptible populations (domestic and wildlife) and epidemiological risk factors. Epidemiologic surveys calculate the disease incidence to facilitate the disease investigation and to frame preventive measures.

STUDIES REFERENCED IN THIS EPISODE   TELOGEN EFFLUVIUM - HAIR LOSS FOLLOWING COVID 19 STUDY 1 (starts at 3:09 ): Lopez-Leon S et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021 Jan 30;2021.01.27.21250617. STUDY 2 (starts at 4:47): Muller-Ramos P et al. Post-COVID-19 hair loss: prevalence and associated factors among 5,891 patients. Int J Dermatol 2022 Jan 26. STUDY 3 (starts at 10:32 ): Fernandez-de-Las-Penas et al. Female Sex Is a Risk Factor Associated with Long-Term Post-COVID Related-Symptoms but Not with COVID-19 Symptoms: The LONG-COVID-EXP-CM Multicenter Study. J Clin Med. 2022 Jan 14;11(2):413.   TELOGEN EFFLUVIUM IN CHILDREN STUDY 4 (starts at 12:45 ): Thomas et al.  Single Centre Retrospective Review ofNutritional Deficiencies Associated With Telogen Effluvium in the Paediatric Population in Canada. J Cut Med Surg Jan 2022 (online)     TRICHOTILLOMANIA  STUDY 5 (starts at 18:44) : Moattari et al. Adverse psychocutaneous effects of prescription stimulant use and abuse: A systematic review. J Dtsch Dermatol Ges. 2022 Jan;20(1):7-15. STUDY 6: (starts at 23:12); Vaccaro et al. Erosive pustular dermatosis of the scalp as local complication of trichotillomania. J Cosmet Dermatol. 2022 Jan 8. 2022 Jan 8     TINEA CAPITIS STUDY 7 (starts at 27:51): Friedland et al. Epidemiologic features and risk of scarring in pediatric patients with kerion celsi. Pediatr Dermatol. 2022 Jan 13. doi: 10.1111/pde.14916. Online ahead of print.  

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus). PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis. Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures. Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118. 2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108.

Hey! Today we talk about the demographic and epidemiological transition and how it pertains to us today. This is really important to understand just in general, and for anyone taking AP Human Geography. Enjoy! Sources: my teacher :) Follow us on our social media: Email: we.are.youth.org@gmail.com Twitter: We Are @weare_youthorg Facebook: We Are Youtube: We Are Pinterest: We Are @weare_youthorg Instagram: We Are @weare_youthorg Website: https://weare-youth.org/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/we-are-aahana-celine/message

Much of our dietary evidence comes from non-randomized epidemiologic data. In this episode, Robert Ostfeld, MD, MSc, FACC, and Walter Willett, MD, DrPH, discuss why findings from prospective, epidemiologic cohort studies are important in informing dietary recommendations, and what dietary principles are healthful across multiple populations, including the following key takeaways: Personal and planetary health are equally important for our own well-being and for that of future generations; a healthy, predominantly plant-based diet can achieve both of these goals. Although sustainable diets are necessary for planetary health, they are not sufficient; improvements in agricultural production, reduction in food waste, and rapid conversion to green energy are all needed. For more, visit www.acc.org/CardioNutrition Subscribe to CardiaCast

Morgellons? Morgellonen? Es kreucht und fleucht angeblich in Deutschlands Masken? All das kommt einem doch suspekt vor. Dennoch kursieren in den Sozialen Netzwerken Videos von Menschen die ihre Masken aufschneiden, bzw. ihre Schnelltest-Wattestäbchen auseinandernehmen und dabei kleine Fäden finden... die sich auch noch bewegen sollen. Was das sein kann und warum dieses Phänomen nicht erst seit Corona Wellen schlägt, das besprechen wir in dieser Folge von Sur/real. Dabei geholfen haben uns auch die Videos von Dr. Mark Benecke (haben wir für euch in den Show Notes verlinkt), die können wir euch wirklich empfehlen. P.S. In zwei Wochen sind wir wieder mit einer neuen Folge Sur/real für euch da! Wer bis dahin mehr von uns sehen möchte, Ihr findet uns hier: Instagram @surrealderpodcast Facebook @surrealderpodcast Lasst uns gerne Feedback da, nutzt hierzu die Podcast Plattform eurer Wahl, unsere Social Media Kanäle oder schreibt uns eine Mail an connect@surreal-podcast.com! Show Notes: Studie des Center for Disease Control (CDC) and Prevention: Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy, Published 25th January 2012 (englisch) Wissenschaftlicher Artikel: History of Morgellons disease: from delusion to definition, published in Clinical, Cosmetic and Investigational Dermatology 2018:11, S. 71–90 (englisch) Wissenschaftlicher Artikel: Morgellons, contested illness, diagnostic compromise and medicalisation, published in Sociology of Health & Illness Vol. 32 No. 4 2010, S. 597–612 (englisch) CORRECTIV Faktencheck: Schwarze Fäden an Abstrichstäbchen für Corona-Tests sind Stofffasern – keine „Parasiten“, von Sarah Thust & Uschi Jonas, 29. März 2021 BR24 #Faktenfuchs: Keine Parasiten auf Schnelltest-Stäbchen, 31.03.2021 DocCheck Flexikon: Dermatozoenwahn Videos von Mark Benecke (Youtube): Mark Benecke

The Center for Epidemiological Studies-Depression (CES-D), originally published by Radloff in 1977, is a 20-item measure that asks caregivers to rate how often over the past week they experienced symptoms associated with depression, such as restless sleep, poor appetite, and feeling lonely. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Scores range from 0 to 60, with high scores indicating greater depressive symptoms.

Welcome back to episode 3. Numerous risk factors have been proposed to contribute to food allergy or sensitization, in this episode, I will address a few of the most researched genetic and environmental risk factors that increase the risk of developing IgE-mediated food allergy. If you would like to find out more please do visit my blog post which will detail everything that was discussed in the podcast. You can find the blog post based on this podcast on my website under blogs. Disclaimer:The information in this podcast is for information and entertainment purposes only.I am not a medical professional so I have never and will never give medical advice. You should always speak to a health care provider about your unique health needs. My opinions are entirely my own. I only discuss published literature in this podcast. I am not responsible for any claims related to the procedures, professionals, products or methods discussed in the podcast, and do does not approve or endorse any products, professionals, services or methods that may be referenced to in this podcast. Instagram: @AllergieswithAyah Website: https://allergieswithayah.wixsite.com/websiteImage description: The image is an infographic, with a light green background. There is a cartoon mustard tub, celery stick and different types of nuts at the bottom left corner. At the bottom right corner there is a cartoon image of a glass of wine, milk carton, tofu, shellfish, crustacean, purple fish and one egg. On the top left corner there are three wheat stalks and sesame and lupin seeds as cartoon images. On the top right there is a logo with a green antibody in a white box. The logo has the words Allergies at the top of the antibody, the word with to the centre left of the antibody and the word Ayah to the centre right of the antibody. At the centre top of the infographic there is the words Allergies with Ayah in written in grey. The word episode 2 is written to the centre left of Ayah's face. In the centre of the image there is a cartoon character depiction of Ayah. Ayah has brown long hair and is smiling. Ayah's hand is together in two fists and she is wearing a purple topReference list Allen, K.J., Koplin, J.J., Ponsonby, A.L., Gurrin, L.C., Wake, M., Vuillermin, P., Martin, P., Matheson, M., Lowe, A., Robinson, M. and Tey, D., (2013). Vitamin D insufficiency is associated with challenge-proven food allergy in infants. Journal of allergy and clinical immunology, 131(4), pp.1109-1116. Asai, Y., Eslami, A., van Ginkel, C.D., Akhabir, L., Wan, M., Ellis, G., Ben-Shoshan, M., Martino, D., Ferreira, M.A., Allen, K. and Mazer, B., (2018a). Genome-wide association study and meta-analysis in multiple populations identifies new loci for peanut allergy and establishes C11orf30/EMSY as a genetic risk factor for food allergy. Journal of Allergy and Clinical Immunology, 141(3), pp.991-1001. Asai, Y., Eslami, A., Van Ginkel, C.D., Akhabir, L., Wan, M., Yin, D., Ellis, G., Ben-Shoshan, M., Marenholz, I., Martino, D. and Ferreira, M.A., (2018b). A Canadian genome-wide association study and meta-analysis confirm HLA as a risk factor for peanut allergy independent of asthma. Journal of Allergy and Clinical Immunology, 141(4), pp.1513-1516. Chalmers JR, Haines RH, Mitchell EJ, Thomas KS, Brown SJ, Ridd M, et al. Effectiveness and cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children (The BEEP trial): protocol for a randomised controlled trial. Trials 2017;18:343. Crespo JF, James JM, Fernandez-Rodriguez C, Rodriguez J. Food Allergy: Nuts and Tree Nuts. Br J Nutr. 2006;96 2:S95–102. Feeney, M., Du Toit, G., Roberts, G., Sayre, P.H., Lawson, K., Bahnson, H.T., Sever, M.L., Radulovic, S., Plaut, M., Lack, G. and Chan, S., 2016. Impact of peanut consumption in the LEAP study: feasibility, growth, and nutrition. Journal of Allergy and Clinical Immunology, 138(4), pp.1108-1118.Grimshaw, K. E., Bryant, T., Oliver, E. M., Martin, J., Maskell, J., Kemp, T., Clare Mills, E. N., Foote, K. D., Margetts, B. M., Beyer, K., & Roberts, G. (2016). Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study. Clinical and translational allergy, 6, 1. https://doi.org/10.1186/s13601-016-0089-8Lack, G., 2008. Epidemiologic risks for food allergy. Journal of Allergy and Clinical Immunology, 121(6), pp.1331-1336.Marenholz, I., Grosche, S., Kalb, B., Rüschendorf, F., Blümchen, K., Schlags, R., Harandi, N., Price, M., Hansen, G. & Seidenberg, J. (2017). 'Genome-wide association study identifies the SERPINB gene cluster as a susceptibility locus for food allergy', Nature communications, 8(1), pp. 1-10. Matsui, T., Tanaka, K., Yamashita, H., Saneyasu, K.-i., Tanaka, H., Takasato, Y., Sugiura, S., Inagaki, N. & Ito, K. (2019). 'Food allergy is linked to season of birth, sun exposure, and vitamin D deficiency', Allergology International, 68(2), pp. 172-177.Perkin MR, Logan K, Marrs T, Radulovic S, Craven J, Flohr C, et al. Enquiring About Tolerance (EAT) study: feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol 2016a 137:1477-86. Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med 2016b ;374: 1733-43. Perkin, M.R., Logan, K., Marrs, T., Radulovic, S., Craven, J., Boyle, R.J., Chalmers, J.R., Williams, H.C., Versteeg, S.A., Van Ree, R. and Lack, G., 2021. Association of frequent moisturizer use in early infancy with the development of food allergy. Journal of Allergy and Clinical Immunology, 147(3), pp.967-976.Savilahti, E. M., Ilonen, J., Kiviniemi, M., Saarinen, K. M., Vaarala, O. & Savilahti, E. (2010). 'Human leukocyte antigen (DR1)-DQB1* 0501 and (DR15)-DQB1* 0602 haplotypes are associated with humoral responses to early food allergens in children',International archives of allergy and immunology,152(2), pp. 169-177.siSchoemaker, A. A., Sprikkelman, A. B., Grimshaw, K. E., Roberts, G., Grabenhenrich, L., Rosenfeld, L., Siegert, S., Dubakiene, R., Rudzeviciene, O. & Reche, M. (2015). 'Incidence and natural history of challenge‐proven cow's milk allergy in European children–EuroPrevall birth cohort',Allergy,70(8), pp. 963-972.Sicherer, S. H., Furlong, T. J., Maes, H. H., Desnick, R. J., Sampson, H. A. & Gelb, B. D. (2000). 'Genetics of peanut allergy: a twin study',Journal of Allergy and Clinical Immunology,106(1), pp. 53-56.Tordesillas, L.,Berin,M. C. & Sampson, H. A. (2017). 'Immunology of foodallergy', Immunity,47(1), pp. 32-50.Van Ginkel, C.D., Flokstra‐de Blok, B.M.J., Kollen, B.J., Kukler, J., Koppelman, G.H. and Dubois, A.E.J., (2015). Loss‐of‐function variants of the filaggrin gene are associated with clinical reactivity to foods. Allergy, 70(4), pp.461-464.Venkataraman, Devasmitha et al. “Filaggrin loss-of-function mutations are associated with food allergy in childhood and adolescence.” The Journal of allergy and clinical immunology vol. 134,4 (2014): 876-882.e4. doi:10.1016/j.jaci.2014.07.033Visscher, P.M., Wray, N.R., Zhang, Q., Sklar, P., McCarthy, M.I., Brown, M.A. and Yang, J., (2017). 10 years of GWAS discovery: biology, function, and translation.The American Journal of Human Genetics,101(1), pp.5-22.

Anyone who's been involved in athletics at any level—professional, college, recreational, or those older individual with the reoccurring aches and pains of general living—appreciates the benefits of over-the-counter non-steroidal anti-inflammatories (NSAID's), or the prescription version, as first-line pharmaceutical drugs to treat pain and localized inflammation—under physician guidance.These medications inhibit cyclooxygenase enzymes, which are responsible for the discomfort associated with overuse issues.Like a financial statement, which lists both assets and liabilities, NSAID's have their own negative aspects, when overused. Those complications, with chronic or overuse, may include cardiovascular (CV) outcomes, hypertension, coronary heart disease, atrial fibrillation, and congestive heart failure, especially with high-risk people.As it pertains to a higher risk population—like American-style football (ASF) athletes of larger sizes, such as the offensive and defensive linemen, retired ASF players, and those ASF players with numerous orthopedic injuries in their medical history, all who later in life may have a higher incidence of hypertension and cardiovascular disease—NSAID use may be contraindicated.According to Nonsteroidal Ant-Inflammatory Drugs and Cardiovascular Risk in American Football, which appeared in the December 2020 issue of Medicine & Science in Sports & Exercise, “ASF participation is associated with the development of early hypertension and acquired pathologic CV phenotypes—all associated with significant weight gain. Epidemiologic data also suggest increased CV mortality among retired professional ASF athletes, who had the largest playing time body mass index (BMI).There are still uncertainties, as it pertains to habitual NSAID use and increased CV risk in AFS.Researchers from Emory University, Georgia Institute of Technology, Woodward Academy in Atlanta, and the Cardiovascular Performance Program at Massachusetts General Hospital in Boston, “sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes.”The testing group of young athletes included a total of 226 ASF players, 60 endurance athletes, and 63 nonathletic controls, who were studied pre and postseason. Echocardiography, vascular applanation tonometry, and clinical data assessment were obtained. Qualitative NSAID use throughout the season was recorded at postseason.It was determined that, “within a large cohort of combined HS and collegiate ASF athletes, habitual NSAID use was more common among those with established CV risk factors, and importantly, increased weight across the ASF season was associated with an increased frequency of NSAID use.”The researchers also said, “second, and just as concerning within this diverse ASF cohort, sport-related ASF NSAID use more commonly began early, in middle school, before full physical maturation.”It was concluded that, “our data suggest that increased weight, a critical pathologic factor linking early ASF-associated CV risk with adverse long-term outcomes, is also associated with increased NSAID use during competitive ASF training.”“Taken together, commented the researchers, “we believe that our findings provide compelling rationale that habitual NSAID use may adversely affect CV risk among competitive ASF athletes and should therefore be considered in the CV risk stratification of high-risk ASF athletes.”As with any medication—prescription or over-the-counter—it's best to be used under the guidance of your personal physician, in order to avoid potential contraindications or complications.

Diet has a significant role in disease development and protection, particularly when it comes to certain diseases like diabetes. More recently, the quality of carbohydrates and fats has been examined more closely for their impact on health. Epidemiologic studies have revealed that consumption of refined carbohydrate-containing diets and/or diets high in saturated fat may be associated with increased prevalence of type 2 diabetes and risk for coronary heart disease. Dietary patterns emphasizing certain nutrients, such as monounsaturated fats (MUFA), while decreasing other components, such as saturated fats or refined, readily digestible carbohydrates, may have favorable effects on cardio-metabolic health. Fresh avocados are a distinctive fruit characterized by their nutrient profile that includes MUFA, dietary fiber and several essential micronutrients and bioactive phytochemicals. A study published in the journal Nutrients (September 2018) investigated the strategy of incorporating fresh avocados into a breakfast meal (replacing mainly carbohydrates with fat by adding unsaturated fats from avocados) on postprandial markers of metabolic and vascular health. Researchers looked at changes in glycemic indices along with changes in markers of endothelial function, inflammation and oxidative stress/damage – each having a role in cardiometabolic health. Tune in to this episode with guest Erin Palinski-Wade RD, CDE, LDN, CPT to learn about: The potential role of fresh avocados in cardiometabolic health and glycemic management in overweight or obese adults Why nutrient-dense foods like fresh avocados are a good choice for people with diabetes The potential benefits of nutrient combinations such as fat and fiber on satiety Dietary habits and other lifestyle factors known to impact diabetes that may improve with mindful eating Strategies for incorporating mindful eating into diabetes management Registered Dietitians, Dietetic Technicians, and Certified Diabetes Educators can earn 1.0 FREE CEU for listening to this podcast episode. This episode is sponsored by Fresh Avocados – Love One Today®  For more information and resources visit: https://bit.ly/2I2xHRN

The Gary Null Show is here to inform you on the best news in health, healing, the environment.        Curb your anxiety by drinking a cup of matcha green tea Kumamoto University (Japan), July 31, 2020      Matcha can reduce anxiety by activating dopamine and serotonin receptors that are linked to anxious behavior, according to researchers from Kumamoto University in Japan. Matcha, which literally means “powdered tea,” refers to the powder made from finely ground leaves of shade-grown tea tree (Camellia sinensis). Matcha has been used medicinally since ancient times. In Japan, in particular, it is used to help people relax, prevent obesity and treat certain skin conditions.   In a recent study published in the Journal of Functional Foods, Japanese researchers find evidence of the mental health benefits offered by matcha.   “The results of our study show that matcha, which has been used as a medicinal agent for many years, may be quite beneficial to the human body,” said Yuki Kurauchi, one of the study authors.   For their study, the researchers looked at the effects of matcha tea powder on mice using an anxiety test for rodents called the elevated plus maze test. This test features an elevated, plus-shaped, narrow platform with two walled arms that provide safety for the test animals. The idea behind the test is that animals experiencing high levels of anxiety will spend more time in the safer, walled-off areas.   Aside from matcha powder, the team also evaluated the effects of different matcha extracts and fractions.   The researchers found that the mice that consumed either matcha powder or matcha extract displayed reduced anxious behavior. They also found that the ethanol extract exhibited a stronger anxiolytic effect than the hot water extract. This meant that matcha contains two anxiety-reducing components, and that the water-insoluble component exerts stronger anxiolytic effects than the water-soluble component.   After conducting behavioral pharmacological analysis, the researchers found that matcha reduces anxiety by activating dopamine D1 and serotonin 5-HT1A receptors. According to studies, these receptors play a significant role in mediating anxiety. The team concluded that while more study is needed, their findings emphasize matcha's beneficial effects on mental health.       The effect of reiki and guided imagery intervention on pain and fatigue in oncology patients Siirt University (Turkey),  31 July 2020.   Absract This study was conducted to investigate the effects of Reiki and guided imagery on pain and fatigue in oncology patients. This quasi-experimental study with a pretest and posttest design was conducted with 180 oncology patients at the oncology clinic of Dicle University Hospital in Turkey, between July 2017 and February 2018. The patients were divided into three groups: Reiki, guided imagery and control, with 60 patients in each group. The Reiki and guided imagery group patients underwent their respective interventions for three consecutive days separately (25-30 min; mean: 15.53 min). The interventions of Reiki and guided imagery reduced pain and fatigue in the oncology patients. It is recommended that oncology nurses use Reiki and guided imagery in patient care.       Decreased concentrations of vitamin B12 associated with increased risk of high-grade cervical lesions Federal University Ouro Preto (Brazil), July 31, 2020   According to news reporting originating in Minas Gerais, Brazil, research stated, “Diet and lifestyle play an important role in etiology of various tumors. Serum concentration of folate and vitamin B12may be associated with carcinogenesis since they are involved in DNA methylation and nucleotide synthesis.”   The news reporters obtained a quote from the research from Federal University Ouro Preto, “However, the role of these micronutrients on development of cervical cancer is still controversial. Thus, the aim of this study was to analyze the association of lower status of folate and vitamin B12 with the risk of pre-neoplastic cervical lesions. Our sample group was divided in Control group (n=120) -women with normal cytology, and Case groups (n=57) -women presenting Atypical Squamous Cells of Undetermined Significance (ASC-US, n=21), Low Grade Squamous Intraepithelial Lesion (LSIL; n=16), and High-Grade lesions (n=20). We obtained cervical samples for cytology analysis and HPV detection, and blood samples for evaluation of serum concentration of folate and vitamin B12. No difference of serum folate was observed among Cases and Control groups. On the other hand, women with High-Grade lesions presented significant lower median concentration of vitamin B12 if compared to another groups. Then, we observed increased risk of High-Grade lesions among participants with low vitamin B12 levels was observed in relation to women that presented high levels of the micronutrient and from Control group [OR (95% CI): 2.09 (0.65-6.76), p=0.216], ASC-US [OR (95% CI): 3.15 (0.82-12.08), p=0.095], and LSIL [OR (95% CI): 3.10 (0.76-12.70), p=0.116]. Low concentration of vitamin B12 was associated with an increased risk of High-Grade cervical lesions.”   According to the news reporters, the research concluded: “Besides, we did not observe any difference of serum folate among women with normal cytology and women with pre-neoplastic cervical lesions.”         Why is cilantro so good for the brain? Science explains University of California at Irvine, July 30, 2020   A study published in the FASEB Journal found that cilantro activates certain potassium channels in the brain which helps prevent seizures.   Also known as coriander, cilantro is an herb that is commonly used in traditional medicine. It has anticonvulsant, anti-depressant and anti-inflammatory properties that make it suitable for treating a host of medical conditions, including epileptic seizures.   But while its health benefits have been extensively studied, the precise mechanism behind cilantro's powerful effects on the body remains obscure. The present study provides a molecular basis for the therapeutic actions of cilantro.   Cilantro activates neuronal potassium channels to alleviate seizures   The Centers for Disease Control and Prevention estimates that about 3.4 million Americans are living with epilepsy. Epilepsy is a neurological disorder characterized by abnormal brain activity that causes seizures or periods of unusual behavior, sensations and loss of awareness.   In the study, researchers at the University of California, Irvine looked at cilantro leaf metabolites to find the source of its antiepileptic activity. Metabolites are the intermediate products of cellular metabolism.   The researchers found that one particular metabolite, the long-chain fatty aldehyde (E)-2-dodecenal, activates several potassium channels in the brain. These channels are part of the voltage-gated potassium channel subfamily Q (KCNQ), which can be found in neurons. According to previous studies, KCNQ dysfunction can lead to severe, treatment-resistant epileptic seizures.   The researchers also found that (E)-2-dodecenal could delay chemically-induced seizures, suggesting its involvement in cilantro's anti-convulsant activity. Geoffrey Abbott, one of the study authors, explained that by binding to a specific part of the potassium channels to open them, (E)-2-dodecenal was able to reduce cellular excitability.   Given these findings, the researchers are optimistic that more effective strategies involving cilantro can be developed for the treatment of epilepsy.       Cannabinoids may affect activity of other pharmaceuticals Penn State University, August 3, 2020   Cannabinoid-containing products may alter the effects of some prescription drugs, according to Penn State College of Medicine researchers. They published information that could help medical professionals make safe prescribing choices for their patients who use prescription, over-the-counter or illicit cannabinoid products.   Kent Vrana, professor and chair of pharmacology at the College of Medicine, and Paul Kocis, a pharmacist at Penn State Health Milton S. Hershey Medical Center, compiled a list of 57 medications that may not function as intended when used with medical cannabinoids, CBD oil (hemp oil) and medical or recreational marijuana. The list was published in the journal Medical Cannabis and Cannabinoids.   The medications on the list have a narrow therapeutic index, meaning they are prescribed at specific doses - enough to be effective, but not enough to cause harm. Vrana says it's important for medical professionals to consider the list when prescribing medical cannabinoids and how it may affect other medications a patient is taking.   To develop the list, the researchers looked at the prescribing information for four prescription cannabinoid medications. This information included a list of enzymes in the body that process the active ingredients in those medications, which can include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). They compared this information against prescribing information from common medications using information available from regulatory agencies like the U.S. Food and Drug Administration to identify where there may be overlap, called a drug-drug interaction. The list contains a variety of drugs from heart medications to antibiotics and antifungals. As one example, researchers identified warfarin, a common anticoagulant that prevents harmful blood clots from forming, as having a potential drug-drug interaction with cannabinoid products. Often prescribed for patients with atrial fibrillation or following cardiac valve replacement, the drug has a narrow therapeutic index, and Vrana cautions that medical professionals consider this potential drug-drug interaction both when prescribing warfarin to patients on prescription cannabinoids or prescribing cannabinoids to a patient taking warfarin.   The researchers say that medical professionals should also consider patient use of CBD oil products and medical and recreational marijuana when using or prescribing drugs on the identified list. Most of those products lack government regulation and there is little to no prescribing or drug-drug interaction information for those products.   "Unregulated products often contain the same active ingredients as medical cannabinoids, though they may be present in different concentrations," Vrana said. "The drug-drug interaction information from medical cannabinoids may be useful as medical professionals consider the potential impact of over-the-counter or illicit cannabinoid products."   Vrana advises that patients be honest with their health care providers about their use of cannabinoid products - from over-the-counter products to recreational marijuana. He says that doing so can help ensure the safe and effective use of prescribed medications.   In addition to the identified list of 57 prescription medications with a narrow therapeutic index that is potentially impacted by concomitant cannabinoid use, a comprehensive list of 139 medications that could have a potential drug-drug interaction with a cannabinoid is available online. Vrana and Kocis plan to routinely update this drug-drug interaction list as newer medications are approved and real-world evidence accumulates.   Kent Vrana received a sponsored research agreement from PA Options for Wellness, a medical cannabis provider and clinical registrant in Pennsylvania, and this research was supported in part by the agreement. The College of Medicine and PA Options for Wellness have a 10-year research agreement designed to help physicians and patients make better informed clinical decisions related to cannabinoids.       Perinatal DHA supplementation improves cognition and alters brain functional organization in experimental research University of Georgia, July 31, 2020   According to news reporting out of the University of Georgia, research stated, “Epidemiologic studies associate maternal docosahexaenoic acid (DHA)/DHA-containing seafood intake with enhanced cognitive development; although, it should be noted that interventional trials show inconsistent findings.”   The news correspondents obtained a quote from the research from University of Georgia: “We examined perinatal DHA supplementation on cognitive performance, brain anatomical and functional organization, and the brain monoamine neurotransmitter status of offspring using a piglet model. Sows were fed a control (CON) or a diet containing DHA (DHA) from late gestation throughout lactation. Piglets underwent an open field test (OFT), an object recognition test (ORT), and magnetic resonance imaging (MRI) to acquire anatomical, diffusion tensor imaging (DTI), and resting-state functional MRI (rs-fMRI) at weaning. Piglets from DHA-fed sows spent 95% more time sniffing the walls than CON in OFT and exhibited an elevated interest in the novel object in ORT, while CON piglets demonstrated no preference. Maternal DHA supplementation increased fiber length and tended to increase fractional anisotropy in the hippocampus of offspring than CON. DHA piglets exhibited increased functional connectivity in the cerebellar, visual, and default mode network and decreased activity in executive control and sensorimotor network compared to CON.”   According to the news reporters, the research concluded: “The brain monoamine neurotransmitter levels did not differ in healthy offspring. Perinatal DHA supplementation may increase exploratory behaviors, improve recognition memory, enhance fiber tract integrity, and alter brain functional organization in offspring at weaning.”       Chlamydia: Greedy for glutamine University of Wurzburg (Germany), August 3, 2020   Chlamydia are bacteria that cause venereal diseases. In humans, they can only survive if they enter the cells. This is the only place where they find the necessary metabolites for their reproduction. And this happens in a relatively simple way: the bacteria create a small bubble in the cell and divide in it over several generations.   What is the decisive step that initiates the reproduction of the bacteria? It has not been known so far. Researchers from Julius-Maximilians-Universität Würzburg (JMU) in Bavaria, Germany, have now discovered it. This is important because the first step in the reproduction of the pathogens is likely to be a good target for drugs.   Glutamine import into the host cell increases   In the case of Chlamydia, the first step is to reprogram the metabolism of their human host cells. The cells then increasingly import the amino acid glutamine from their environment. If this does not work, for example because the glutamine import system is out of order, the bacterial pathogens are no longer able to proliferate. This was reported by a JMU team led by Dr. Karthika Rajeeve, who has meanwhile been awarded a professorship at the Aarhus University in Denmark, and Professor Thomas Rudel in the journal Nature Microbiology.   "Chlamydiae need a lot of glutamine to synthesize the ring-shaped molecule peptidoglycan," explains Professor Rudel, who heads the Chair of Microbiology at the JMU Biocenter. In bacteria, this ring molecule is generally a building material of the cell wall. Chlamydiae use it for the construction of a new wall that is drawn into the bacterial cell during division.   Next, the JMU team hopes to clarify the importance of the glutamine metabolism in chronic chlamydiae infections. This might provide information that might help to better understand the development of severe diseases as a result of the infection.   Chlamydiae cause most venereal diseases in Germany. The bacteria are sexually transmitted and can cause inflammation in the urethra, vagina or anal area. If an infection is detected in time, it can be treated well with antibiotics.   Around 130 million people worldwide are infected with Chlamydia. The biggest problem is that the infection usually proceeds without noticeable symptoms. This makes it easier for the pathogen to spread, this leads to severe or chronic diseases such as cervical and ovarian cancer.       Baby boomers show concerning decline in cognitive functioning Trend reverses progress over several generations, study finds Ohio State University, August 3, 2020   In a reversal of trends, American baby boomers scored lower on a test of cognitive functioning than did members of previous generations, according to a new nationwide study.   Findings showed that average cognition scores of adults aged 50 and older increased from generation to generation, beginning with the greatest generation (born 1890-1923) and peaking among war babies (born 1942-1947).   Scores began to decline in the early baby boomers (born 1948-1953) and decreased further in the mid baby boomers (born 1954-1959).   While the prevalence of dementia has declined recently in the United States, these results suggest those trends may reverse in the coming decades, according to study author Hui Zheng, professor of sociology at The Ohio State University.   "It is shocking to see this decline in cognitive functioning among baby boomers after generations of increases in test scores," Zheng said.   "But what was most surprising to me is that this decline is seen in all groups: men and women, across all races and ethnicities and across all education, income and wealth levels." Results showed lower cognitive functioning in baby boomers was linked to less wealth, along with higher levels of loneliness, depression, inactivity and obesity, and less likelihood of being married.   The study was published online recently in the Journals of Gerontology: Social Sciences.   Zheng analyzed data on 30,191 Americans who participated in the 1996 to 2014 Health and Retirement Survey, conducted by the University of Michigan. People over 51 years old were surveyed every two years.   As part of the study, participants completed a cognitive test in which they had to recall words they had heard earlier, count down from 100 by 7s, name objects they were shown and perform other tasks.   Other research has shown that overall rates of mortality and illness have increased in baby boomers, but generally found that the highly educated and wealthiest were mostly spared.   "That's why it was so surprising to me to see cognitive declines in all groups in this study," Zheng said. "The declines were only slightly lower among the wealthiest and most highly educated."   Zheng also compared cognition scores within each age group across generations so that scores are not skewed by older people who tend to have poorer cognition. Even in this analysis, the baby boomers came out on bottom.   "Baby boomers already start having lower cognition scores than earlier generations at age 50 to 54," he said.   The question, then, is what has happened to baby boomers? Zheng looked for clues across the lifetimes of those in the study.   Increasing cognition scores in previous generations could be tied to beneficial childhood conditions - conditions that were similar for baby boomers, Zheng said.   Baby boomers' childhood health was as good as or better than previous generations and they came from families that had higher socioeconomic status. They also had higher levels of education and better occupations.   "The decline in cognitive functioning that we're seeing does not come from poorer childhood conditions," Zheng said.   The biggest factors linked to lower cognition scores among baby boomers in the study were lower wealth, higher levels of self-reported loneliness and depression, lack of physical activity and obesity.   Living without a spouse, being married more than once in their lives, having psychiatric problems and cardiovascular risk factors including strokes, hypertension, heart disease and diabetes were also associated with lower cognitive functioning among people in this generation.   "If it weren't for their better childhood health, move favorable family background, more years of education and higher likelihood of having a white-collar occupation, baby boomers would have even worse cognitive functioning," Zheng said.   There were not enough late baby boomers (born in 1960 or later) to include in this study, but Zheng said he believes they will fare no better. The same might be true for following generations unless we find a solution for the problems found here, he said.   While many of the problems linked to lower cognitive functioning are symptoms of modern life, like less connection with friends and family and growing economic inequality, other problems found in this study are unique to the United States, Zheng said. One example would be the lack of universal access and high cost of health care.   "Part of the story here are the problems of modern life, but it is also about life in the U.S.," he said.   One of the biggest concerns is that cognitive functioning when people are in their 50s and 60s is related to their likelihood of having dementia when they are older. "With the aging population in the United States, we were already likely to see an increase in the number of people with dementia," Zheng said.   "But this study suggests it may be worse than we expected for decades to come."       Study: Experiencing childhood trauma makes body and brain age faster Findings could help explain why children who suffer trauma often face poor health later in life Harvard University, August 2, 2020   Children who suffer trauma from abuse or violence early in life show biological signs of aging faster than children who have never experienced adversity, according to research published by the American Psychological Association. The study examined three different signs of biological aging--early puberty, cellular aging and changes in brain structure--and found that trauma exposure was associated with all three.   "Exposure to adversity in childhood is a powerful predictor of health outcomes later in life--not only mental health outcomes like depression and anxiety, but also physical health outcomes like cardiovascular disease, diabetes and cancer," said Katie McLaughlin, PhD, an associate professor of psychology at Harvard University and senior author of the study published in the journal Psychological Bulletin. "Our study suggests that experiencing violence can make the body age more quickly at a biological level, which may help to explain that connection."   Previous research found mixed evidence on whether childhood adversity is always linked to accelerated aging. However, those studies looked at many different types of adversity--abuse, neglect, poverty and more--and at several different measures of biological aging. To disentangle the results, McLaughlin and her colleagues decided to look separately at two categories of adversity: threat-related adversity, such as abuse and violence, and deprivation-related adversity, such as physical or emotional neglect or poverty.   The researchers performed a meta-analysis of almost 80 studies, with more than 116,000 total participants. They found that children who suffered threat-related trauma such as violence or abuse were more likely to enter puberty early and also showed signs of accelerated aging on a cellular level-including shortened telomeres, the protective caps at the ends of our strands of DNA that wear down as we age. However, children who experienced poverty or neglect did not show either of those signs of early aging.   In a second analysis, McLaughlin and her colleagues systematically reviewed 25 studies with more than 3,253 participants that examined how early-life adversity affects brain development. They found that adversity was associated with reduced cortical thickness - a sign of aging because the cortex thins as people age. However, different types of adversity were associated with cortical thinning in different parts of the brain. Trauma and violence were associated with thinning in the ventromedial prefrontal cortex, which is involved in social and emotional processing, while deprivation was more often associated with thinning in the frontoparietal, default mode and visual networks, which are involved in sensory and cognitive processing.   These types of accelerated aging might originally have descended from useful evolutionary adaptations, according to McLaughlin. In a violent and threat-filled environment, for example, reaching puberty earlier could make people more likely to be able to reproduce before they die. And faster development of brain regions that play a role in emotion processing could help children identify and respond to threats, keeping them safer in dangerous environments. But these once-useful adaptations may have grave health and mental health consequences in adulthood.   The new research underscores the need for early interventions to help avoid those consequences. All of the studies looked at accelerated aging in children and adolescents under age 18. "The fact that we see such consistent evidence for faster aging at such a young age suggests that the biological mechanisms that contribute to health disparities are set in motion very early in life. This means that efforts to prevent these health disparities must also begin during childhood," McLaughlin said.   There are numerous evidence-based treatments that can improve mental health in children who have experienced trauma, McLaughlin said. "A critical next step is determining whether these psychosocial interventions might also be able to slow down this pattern of accelerated biological aging. If this is possible, we may be able to prevent many of the long-term health consequences of early-life adversity," she says.

Dr. Caroline Buckee is the associate director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. I. Holmdahl and C. Buckee. Wrong but Useful — What Covid-19 Epidemiologic Models Can and Cannot Tell Us. N Engl J Med 2020;383:303-305. E.C. Schneider. Failing the Test — The Tragic Data Gap Undermining the U.S. Pandemic Response. N Engl J Med 2020;383:299-302.

Let's learn about the epidemiological method, which is similar to the scientific method but for epidemiology studies!

Nilay Shah, PhD, chair of the division of health care policy and research, Mayo Clinic, explains the information and factors that go into the predictive models for the impact of COVID-19; examines the reliability of the Susceptible, Exposed, Infected, and Recovered (SEIR) model for policy decisions; breaks down some of the confounding effects of various input assumptions on the models; and more.

Vaccine Hesitancy The sun rises over the San Joaquin Valley, California, today in April 23, 2020.This week the FDA approved the first IV medication for prophylaxis of migraine: Epti-nezu-mab- jjmr (brand name Vyepti®). This is a humanized monoclonal antibody that blocks the calcitonin gene-related peptide (CGRP). Blocking this receptor results in prevention of migraines. Epti-nezu-mab is administered every 3 months(1).Do you remember those headlines in January 2019? “Insulin loses its place as the first-line injectable treatment”(2) for type 2 diabetes. The family of GLP-1 agonists (the medications that end in “tide”, such as liraglutide, dulaglutide, exenatide, etc.) became the preferred injectable for most patients with type 2 diabetes. In case you didn’t know, in September 2019, the FDA approved the first ORAL GLP1 agonist for use in type 2 diabetes(3). Rybelsus® (semaglutide) (yeah! No needles!). The benefits in weight loss and glycemic control of the ORAL semaglutide (Rybelsus®) are comparable to the INJECTABLE semaglutide (Ozempic®).In case you did not know, in July 2019, the European Commission approved the first oral medication for adults with type 1 diabetes: Dapaglifozin (Forxiga® in Eruope, Farxiga® in USA). It is an SGLT2 inhibitor previously approved for TYPE 2 diabetes, but now it is being used in Europe for TYPE 1 diabetes as well. The FDA did not approve Farxiga for Type 1 diabetes in the USA. Now you know it, there is an IV medication for migraine prophylaxis (Vyepti®), an oral GLP-1 agonist for diabetes type 2 (Rybelsus®), and at least one oral medication for Type 1 diabetes (Forxiga, used only in Europe).  ____________________________Quote: “Being aware of your ignorance gives you the gift of curiosity” –Unknown Author (6)“Curiosity killed the cat… but satisfaction brought it back”. Curiosity can be a driving force to guide you in your residency training. When used properly, curiosity will take you to unexplored areas and will increase your knowledge and expertise to help more and more patients. I am happy to be with you today in another episode of our podcast. My name is Hector Arreaza, and I am a faculty in the Rio Bravo Family Medicine Residency Program. We received feedback about a word that I mispronounced: Irrelevant. Also, during a previous episode we talked about leucorrhea. Do you know another cause of leucorrhea in little girls? Tiny pinworms: Enterobius vermicularis. Today we have a different kind of episode. I left Dr Saito and Dr Manzanares take over the main part of the podcast. Just a warning, it is rated PG-13 today, enjoy it.   Question number 1: Who are you? This is Steven Saito. I am a former Navy doctor, having spent 6.5 years in the service primarily working out of a branch clinic having taken on a variety of additional duties including prior department head and senior medical officer.  I have since come to Rio Bravo BFM to continue to give my service. I’m here to give you your weekly suppository of information. Relax and let it in (joke). Question number 2: What did you learn this week? As an introduction, Prazosin is an alpha-1 blocker used for treatment of PTSD. It may cause priapism, which is defined as painful erections longer than 4 hours. If this happens to you, just call more people (joke). Main topic: So, I encountered a mother who was against vaccinations.  I wanted to talk a little about vaccine hesitancy and approach to discussion with parents/patients for vaccination.  Hold onto your butts because this is a topic that definitely will not get any controversy or angry emails from Facebook moms groups! We reviewed information on vaccine hesitancy from the World Health Organization, the Center for Disease Control, and the AAFP.  In a “short” 253-page paper, the World Health Organization laid out its review of literature and its conclusions for strategies for addressing vaccine hesitancy.  It found that there are few well-studied strategies for addressing vaccine hesitancy due to wide variation in studies for setting and target populations. This 2014 paper acknowledges that vaccine hesitancy is a rather novel issue at the time of this study.  However, they did condense the useful information that was gleaned into a 2-hr PowerPoint that I’m going to attempt to condense into something that hopefully will not put you to sleep on the drive home from work. First, we have to address what hesitancy is.  It is not outright refusal but whether or not the patient/parent has uncertainty.  There will be people that refuse regardless of whatever information is presented. There are multiple factors which contribute to hesitancy:Complacency:  people feel that there is low risk or that the disease are not dangerous enough and therefore don’t prioritize it;Confidence: lack of trust either in vaccines or health authorities. Patients get multiple inputs from that can influence their confidence including media/politics/religion/culture/personal knowledge;Convenience: as it relates to barriers to access/availability; WHO recognizes that there may not be any one specific measure to overcome hesitancy but there are general recommendations include: Default conversation: Start with presumption of vaccination as default: “It’s time for your vaccination” or “You are due for XYZ”, as opposed to “Do you want your vaccinations?”. This reinforces our understanding of the importance of vaccinations as opposed to sounding ambivalent on the necessity. Motivational interviewing: A majority of patients are likely to comply with health maintenance. For those who don’t, it is generally not recommended to take a directive or argumentative response as that style of communication can result in decreased trust and has shown vaccine uptake does not improve.  A better recommendation would be to start with motivational interviewing.  Motivational interviewing is focused on collaborative and patient centered exploration of their hesitancy with a focus on how to change attitude or behavior. Some principles of motivational interviewing include: Open-ended questions:Use “what”, “why”, “how”, “tell me…” to explore reasons behindhesitancyReflect and respondSimple reflection:“I understand that you are afraid.”Complex reflection: “You want to make the best choice for your child but you are nervous.”Affirm strengths and validate concern“It is great that you are starting to think about vaccines.”“The health of your children is important to you.” “Protecting yourself from illness is important for you and the health of your community.”Ask-Provide-VerifyAsk information on what they know: “So what do you already know about vaccination?”Provide information:“Could I provide you with some information, based on what you just shared?”Verify that they understood: “Given our discussion, how do you view the decision now? Remember I am here to help talk through any concerns you may have.”Summarize “The reason that’s important is…”“What that means to you is…”“The main point to remember is….” At this point during the traditional 2-hr PowerPoint involves some roleplaying, so grab your dice and where going to roll up some characters and fight a dragon. Build trust: Healthcare workers can work toward building trust by both demonstrating competence and caring.  Humans are emotional and simply demonstrating your competence / reason / data may not be enough.  It is okay to admit you do not know at a particular moment. Frequently-Asked Questions about Vaccines (WHO)Can vaccinations lead to infertility?No, vaccinations cannot lead to infertility. In fact, medical experts suggest that some vaccines actually protect fertility indirectly by preventing the need for treatment. Can vaccines cause harmful side effects, illness and even death?No, vaccines are very safe. Most side effects from vaccines are minor and temporary, such as a sore arm or mild fever. Serious adverse events or death are VERY rare (e.g. 1 per millions of doses) for most vaccines. Can needles used for immunization cause infection?For every vaccine, we always use one-time or auto-disable syringes that cannot be reused, which eliminates the risk of transmitting infections from needles. Isn’t giving three needles too many in one visit?No, receiving multiple vaccines in one visit is completely safe as you/your child’s immune system is strong enough to handle them.  “Won’t breast feeding protect babies from infection?”Yes, breast milk will give some protection against some infection, but it does not have the direct ability to prevent infection like vaccines. Vaccines are very specific to the given infection and their prevention capacity is very high. “Can vaccines cause the infection they are supposed to prevent?”Inactivated vaccines do not have live germs and cannot cause infections. Live vaccines have weakened germs that are unable to cause disease in healthy people. Rarely a mild form of infection may occur.  “Is protection from natural infection more effective protection?”Natural infection comes with the risks of serious complications related to that infection. With vaccines, the immune system is stimulated to develop protection without infection, hence it is more effective.  “Shouldn’t vaccines be delayed until children are older and there is less risk of side effects?”There is no evidence that side effects are more common in infants/babies than older children. Delaying vaccines leaves young children at risk of the disease and its complications. Other resources to address vaccination hesitancy: The CDC and the AAFP has a very similar approach so I won’t be reiterating. Although I did find some nice handouts on their website including a handout to make sure that parents understand the risks and responsibilities for their decision. On the AAFP website there are some videos to demonstrate motivational interviewing: https://www.aafp.org/patient-care/public-health/immunizations/video.html.    A Review of Anti-Vaccination LiteratureNow, to discuss more controversial stuff including a look at antivaccination literature: Now to start with let me be clear, antivaccination arguments are difficult to fully quantify because new arguments can be added without evidence, individuals may have unique responses, and the memetic mutations on Facebook and other online communities change stories at alarming regularity so I will be focusing on the more common concerns that I have seen. Autism: Let me be frank, there is no known connection between vaccinations and autism. Epidemiologic evidence does not support an association between immunization and Autism Spectrum disorder, but let’s discuss some of the reasons why our population may be concerned. There is an apparent increase in autism rates in the 1990s. Two primary factors seem be associated with this increase: There was a definitional change in Autism to allow a greater number of children to get the diagnosis.  This means that children who may have been given another diagnosis or had been low enough on the spectrum may not have been categorized.  From an outsider perspective, this would look like a doubling of incidence. The second was that we change the way we do surveillance including active surveillance.  As part of routine screening for toddlers, the M-CHAT was introduced with an update in 2009 to the M-CHAT R/F.  Note that this means that the prior incidence was likely higher than previously thought which may represent our prior lack of identifying individuals who may have needed the additional services.  Let me be further clear: it is a good thing that we are identifying more individuals.  By identifying more children on the spectrum, they can access interventions to be more successful later in life for which they would otherwise be denied. A study in 1998, published by Mr Wakefield (formerly a doctor who lost his credentials) was found to be fraudulent, and in 2004, ten out of the thirteen authors retracted their statement and the Lancet fully retracted it in 2010.Since then, multiple additional studies have demonstrated no epidemiological association with vaccination and autism.  In short, those receiving the vaccine and those who did not, had autism at the same incidence. Other studies which have sought to demonstrate a biologic mechanism to demonstrate a causal link have to failed to demonstrate such.Thimerosal:Thimerosal is a mercury-containing preservative used in multidose vials for vaccines. The mercury it contains, prevents the growth of dangerous bacteria and fungus. In 1999, the FDA removed mercury and thimerosal for as many products as possible. The use of thimerosal has been removed from childhood vaccinations. Now, we use single-use vials for vaccines instead of multidose vials. Mercury in vaccines is not the cause of autism.Mistrust of science.Several people will not believe in science, but discussing that may take a little longer. Question number 3: Why is that knowledge important for you and your patients? Vaccines are good and useful, but sometimes we do not do a good job at communicating to our patients due to long lists of complaints. Once there is a COVID 19 vaccination, we will face some resistance. Question number 4: How did you get that knowledge? As a general rule, I refer to multiple online sources like UpToDate to read articles and get suggestions for primary source citation. Check the bibliography from UTD to see their sources and see if you agree with their evidence for your evidence-based medicine and primary sources.  However, for this talk I wanted to get some additional sources to discuss.  My usual go to locations for additional broad information is to first start with important medical institutions including the Center for Disease Control, World Health Organization, and AAFP. Question number 5: Where did that knowledge come from? See details below in the references. ____________________________“Speaking Medical” (Medical word of the Week) by Hasaney SinHave you even wonder how to say B.O. in medical terms? Bromhidrosis is a condition of abnormal or offensive body odor, to a large extent determined by apocrine gland secretion, although other sources may play a role. Apocrine glands are located on the axillae, perianal area, and some parts of the external genitalia. Perspiration itself actually has no odor, but when sweat comes in contact with bacteria, bromhidrosis can occur. So, next time when you encounter a patient with B.O., called it the right way, bromhidrosis. I am very thankful for my prescription strength deodorant, or else I would be dealing with bromhidrosis.____________________________“Espanish Por Favor” (Spanish Word of the Week) by Roberto Velazquez“Hey, muñeca, qué linda eres”. This is compliment a man can say to a cute girl walking down the street. This is Dr Rava on your section Espanish Por Favor. Today’s Spanish word is Muñeca. Muñeca means doll, as in a toy such as Barbie, but it also refers to a body part, the wrist. Hearing this word is fairly common, and it is the appropriate word to use even in medical terminology. So, don’t get confused when people tells you that their muñeca is broken or twisted or that it hurts because they are talking about the wrist, not their Barbie doll. The way your patient will complain may sound, “Doctor, me torcí la muñeca,” meaning to say, “Doctor, I think I hurt my wrist.” Once a patient called me muñeco, but that’s a different story. Now you know the Spanish word of the week, muñeca. All you need to do now is to assess your patient’s muñeca.  ____________________________“For your Sanity” (Medical joke of the day)by Steven Saito I delivered a beautiful baby in the hospital recently, the husband pulls me aside to thank me and asks: “So, doc, when is the soonest we can have sex again?” I looked at him, winked, and said: “I’ll meet you in the parking lot in 10 minutes”.____________________________Conclusion: Now we conclude our episode number 9, “Vaccine Hesitancy”. We reviewed how to deal with patients (or parents) who are unsure about their shots. We hope to have that kind of discussion when an effective and safe vaccine against SARS-CoV2 is created (fingers and toes crossed). We were reminded of the medical word for B.O., bromhidrosis, which is probably the “ultimate human fragrance” without deodorants; and then we learned how to say wrist is Spanish, muñeca. We’ll see you next week.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Lisa Manzanares, Steven Saito, Roberto Velazquez, and Hasaney Sin. Audio edition: Suraj Amrutia. See you soon! _________________________References:Pain Medicine News, Apr 2020, Vol 18, Number 4, page 4, PainMedicineNews.com.Dotinga Randy, “New Diabetes Guidelines, Insulin loses its place as the first-line injectable treatment”, Family Practice News, January 2019, Vol 49, No. 1, Page 1, “FDA approves first oral GLP-1 treatment for type 2 diabetes”, September 20, 2019, https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-glp-1-treatment-type-2-diabetes“Rybelsus (Oral Semaglutide) Review”, http://mydiabetesvillage.com/rybelsus-review/  Healio Endocrine Today, “Europe embraces, FDA rejects use of SGLT inhibitors for type 1 diabetes”, July 23, 2019. https://www.healio.com/endocrinology/diabetes/news/online/%7B59034289-fcf0-4cd2-888f-23c57e85bfcc%7D/europe-embraces-fda-rejects-use-of-sglt-inhibitors-for-type-1-diabetes“Ignorance Breeds More Ignorance”, posted on November 23, 2017, Exploring Your Mind, https://exploringyourmind.com/ignorance-breeds-ignorance/  “Strategies for Addressing Vaccine Hesitancy, A systematic Review”, World Health Organization, October 2014, https://www.who.int/immunization/sage/meetings/2014/october/3_SAGE_WG_Strategies_addressing_vaccine_hesitancy_2014.pdf?ua=1Understanding Thimerosal, Mercury, and Vaccine Safety; Centers for Disease Control and Prevention, CDC.gov, reviewed in February 2013, https://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-thimerosal-color-office.pdfAAFP, Conversations: Improving Adult Immunizations Rates Using Simple and Strong Recommendations, https://www.aafp.org/patient-care/public-health/immunizations/video.html 

Having proper immune support and health is imperative to putting you in a better place to handle stress, sickness, or anything that life throws your way. There is a lot going on in the world right now, and while we certainly don’t have the answers or a cure for Coronavirus, we do have science based studies that show there are ways to help reduce cortisol levels and support your immune system. In this episode we take a deep dive into all things immune-related and share our best research-backed tips to help you stay healthy and feel your best!  In this episode you’ll learn:  Why smoking cigarettes or vaping nicotine can negatively impact your immune system  Why it’s important to support your immune system with a wide variety of healthy foods, especially fruits and vegetables  That acute (moderate to vigorous intensity) exercise is beneficial to the immune system  That obesity and chronic inflammation can have an impact on immune function  Why it’s so important to drink alcohol in moderation, especially when it comes to immune health  How alcohol can negatively affect different aspects of your health  Why it's important for immune function to find healthy ways to minimize chronic stress  A few ways Amanda and Chris deal with stress  About some supplements that have been shown to help promote relaxation and reduce cortisol (Magnesium, Ashwagandha, B Complex, Reishi, Omega 3, GABA, 5HTP, Theanine, Cava, Valerian Root, Lemon Balm) The role caffeine can play in stress and immune health  Why maintaining connection with others is helpful for reducing cortisol levels  How activities like chewing gum and listening to music can help with stress  That quality sleep is crucial to preventing and fighting viruses Why maintaining a healthy gut is imperative to nutrient absorption and immune health That spending time outside can help your body synthesize vitamin D and help reduce the likelihood of you getting sick  About some foods that contain high amounts of vitamin D  How immune strength changes as you get older  About the lack of connection between weather and increased risk of sickness  That certain herbs can have antiviral properties and immunostimulatory effects  References:  Nicotine increases cortisol levels, while reducing B cell antibody formation and T cells' response to antigens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352117/  A study in the American Journal of Medicine showed that moderate exercise reduced incidents of the cold: https://www.amjmed.com/article/S0002-9343(06)00782-0/fulltext Epidemiologic studies consistently show decreased levels of inflammatory biomarkers in adults with higher levels of physical activity and fitness, even after adjustment for potential confounders such as BMI: https://www.sciencedirect.com/science/article/pii/S2095254618301005 High exercise training workloads, competition events, and the associated physiological, metabolic, and psychological stress are linked with transient immune perturbations, inflammation, oxidative stress, muscle damage, and increased illness risk: https://www.sciencedirect.com/science/article/pii/S2095254618301005 Strong evidence indicating that excess fat stores negatively impact immune function and defense from viruses or parasites in obese individuals: https://www.ncbi.nlm.nih.gov/pubmed/22414338  This study shows that there’s a positive feedback loop between local inflammation in fat tissue and altered immune response, and both of these contribute to the development of related metabolic complications: https://www.ncbi.nlm.nih.gov/pubmed/22429824 Alcohol consumption does not have to be chronic to have negative health consequences: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590612/ Sleep strengthens T-cells, which are a type of immune cells that fight against regular pathogens: https://rupress.org/jem/article/216/3/517/120367/G-s-coupled-receptor-signaling-and-sleep-regulate Meditation, breathing into diaphragm, yoga, mindfulness: https://www.sciencedirect.com/science/article/abs/pii/S002239561500206X https://www.sciencedirect.com/science/article/abs/pii/S1555415516001732 Supplements: https://www.ncbi.nlm.nih.gov/pubmed/19865069  Exercise: https://www.ncbi.nlm.nih.gov/pubmed/12672148  Chewing gum may help lower cortisol levels: https://www.sciencedirect.com/science/article/abs/pii/S0195666312000943 Spend time with friends and family: https://www.ncbi.nlm.nih.gov/pubmed/10941275 Physical touch reduces salivary cortisol and increases oxytocin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323947/  https://www.ncbi.nlm.nih.gov/pubmed/19027101 Laughing: https://www.ncbi.nlm.nih.gov/pubmed/12652882  A 2010 randomized, double-blind, placebo-controlled trial published in the American Journal of Clinical Nutrition showed that vitamin D helped reduced your likelihood of developing the flu: https://www.ncbi.nlm.nih.gov/pubmed/20219962 Georgetown University Medical Center researchers found that sunlight, through a mechanism separate than vitamin D production, energizes T cells that play a central role in human immunity: https://gumc.georgetown.edu/news-release/sunlight-offers-surprise-benefit-it-energizes-infection-fighting-t-cells/  Herbs: https://www.ncbi.nlm.nih.gov/pubmed/11399518

Few things in life are more beneficial than a good night's sleep. But for millions of people, especially those in benzo withdrawal, this is easier said than done. Learn some tips and tricks which may help you get the rest you so desperately need. In today's episode, we'll tackle the withdrawal symptoms of insomnia and nightmares. We'll also answer a question on taper symptoms, discuss how long psychological symptoms may continue, and join D for a personal anniversary celebration. https://www.easinganxiety.com/post/the-restless-pursuit-of-rest-insomnia-in-benzo-withdrawal-bfp032Video ID: BFP032 Chapters 00:57 Introduction10:40 Mailbag21:20 Feature45:58 Moment of Peace  Episode Summary Today, we are going to take a look at sleeping symptoms in benzo withdrawal. This includes insomnia and nightmares. We also will answer a couple of questions from the mailbag, and share one comment. In addition, D will share a personal anniversary regarding his own recovery.  Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. MAILBAGTHE ASHTON MANUAL: https://benzo.org.uk/manual/FEATURE: Insomnia in Benzo WithdrawalAshton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.“Binge-watching television linked with insomnia and fatigue.” Spectator Health. August 15, 2017. Accessed August 15, 2017. https://health.spectator.co.uk/binge-watching-television-linked-with-insomnia-and-fatigue/.Exelmans, Liese, Jan Van den Bulck. “Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal.” Journal of Clinical Sleep Medicine 15(08)(2017):1001-8. Accessed August 15, 2017. http://jcsm.aasm.org/viewabstract.aspx?pid=31062.Ford, D. “Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?” JAMA262(11):1479-84. Accessed March 23, 2017. doi:10.1001/jama.262.11.1479.Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. https://easinganxiety.com/book. Foster, Helen. “Not sleeping? Best insomnia cure could be ignoring it.” Daily Telegraph. September 20, 2017. Accessed October 1, 2017. http://www.dailytelegraph.com.au/lifestyle/health/body-soul-daily/not-sleeping-best-insomnia-cure-could-be-ignoring-it/news-story/0734f87ce37af05d024619d4d9beaff5.Gardner, R.S. Isaac. “Why Are Benzodiazepines and Z-Drugs Still Prescribed Indefinitely For Insomnia?” Brain Blogger. February 11, 2016. Accessed March 6, 2017. http://brainblogger.com/2016/02/11/why-are-benzodiazepines-and-z-drugs-still-prescribed-indefinitely-for-insomnia/.Lewin, Evelyn. “Worrying about insomnia may be worse than lack of sleep.” WAtoday. November 15, 2017. Accessed November 16,2017. https://www.watoday.com.au/lifestyle/health-and-wellness/worrying-about-insomnia-may-be-worse-than-lack-of-sleep-20171115-gzlsow.html.Pardini, Cassandra. “Melatonin Compared With Zolpidem for Hospital-Related Insomnia.” MPR. July 3, 2019. Accessed August 15, 2019. https://www.empr.com/home/news/melatonin-compared-with-zolpidem-for-hospital-related-insomnia/.Shahly, Victoria, et al. “The Associations of Insomnia With Costly Workplace Accidents and Errors: Results From the America Insomnia Survey.” JAMA Psychiatry 69(10)(October 2012):1054-63. Accessed April 6, 2018. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1370486.Spence, D. Warren, et al. “Acupuncture Increases Nocturnal Melatonin Secretion and Reduces Insomnia and Anxiety: A Preliminary Report.” Journal of Neuropsychiatry February 1, 2004. Accessed July 11, 2008. https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.16.1.19.Stoianovici, Robyn, Luigi Burnetti, and Christopher D. Adams. “Comparison of Melatonin and Zolpidem for Sleep in an Academic Community Hospital: An Analysis of Patient Perception and Inpatient Outcomes.” Journal of Pharmacy Practice. June 25, 2019. Accessed August 15, 2019. https://doi.org/10.1177/0897190019851888.Tracy, Phillip. “Somnox: This Bean-Shaped Cuddle Robot Is Designed to Fight Insomnia.” DailyDot.com. November 24, 2017. Accessed November 25, 2017. https://www.dailydot.com/debug/somnox-robot-kickstarter/.  The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://www.youtube.com/@easinganx DISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITSMusic provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

Few things in life are more beneficial than a good night's sleep. But for millions of people, especially those in benzo withdrawal, this is easier said than done. Learn some tips and tricks which may help you get the rest you so desperately need.In today's episode, we'll tackle the withdrawal symptoms of insomnia and nightmares. We'll also answer a question on taper symptoms, discuss how long psychological symptoms may continue, and join D for a personal anniversary celebration. Welcome to Episode #32 Today, we are going to take a look at sleeping symptoms in benzo withdrawal. This includes insomnia and nightmares. We also will answer a couple of questions from the mailbag, and share one comment. In addition, D will share a personal anniversary regarding his own recovery. But first, let's list the resources used in this episode, and then we'll dive deeper into the content of episode 32. Episode Index Each time listed below is in minutes and seconds. Introduction: 0:57Mailbag: 10:40Feature: 21:20Moment of Peace: 44:35 Episode Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. MAILBAGTHE ASHTON MANUAL: https://benzo.org.uk/manual/ FEATURE: Insomnia in Benzo WithdrawalAshton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.. “Binge-watching television linked with insomnia and fatigue.” Spectator Health. August 15, 2017. Accessed August 15, 2017. https://health.spectator.co.uk/binge-watching-television-linked-with-insomnia-and-fatigue/. Exelmans, Liese, Jan Van den Bulck. “Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal.” Journal of Clinical Sleep Medicine 15(08)(2017):1001-8. Accessed August 15, 2017. http://jcsm.aasm.org/viewabstract.aspx?pid=31062. Ford, D. “Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?” JAMA 262(11):1479-84. Accessed March 23, 2017. doi:10.1001/jama.262.11.1479.Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. http://www.benzofree.org/book.Foster, Helen. “Not sleeping? Best insomnia cure could be ignoring it.” Daily Telegraph. September 20, 2017. Accessed October 1, 2017. http://www.dailytelegraph.com.au/lifestyle/health/body-soul-daily/not-sleeping-best-insomnia-cure-could-be-ignoring-it/news-story/0734f87ce37af05d024619d4d9beaff5. Gardner, R.S. Isaac. “Why Are Benzodiazepines and Z-Drugs Still Prescribed Indefinitely For Insomnia?” Brain Blogger. February 11, 2016. Accessed March 6, 2017. http://brainblogger.com/2016/02/11/why-are-benzodiazepines-and-z-drugs-still-prescribed-indefinitely-for-insomnia/. Lewin, Evelyn. “Worrying about insomnia may be worse than lack of sleep.” WAtoday. November 15, 2017. Accessed November 16,2017. https://www.watoday.com.au/lifestyle/health-and-wellness/worrying-about-insomnia-may-be-worse-than-lack-of-sleep-20171115-gzlsow.html. Pardini, Cassandra. “Melatonin Compared With Zolpidem for Hospital-Related Insomnia.” MPR. July 3, 2019. Accessed August 15, 2019. https://www.empr.com/home/news/melatonin-compared-with-zolpidem-for-hospital-related-insomnia/.Shahly, Victoria, et al. “The Associations of Insomnia With Costly Workplace Accidents and Errors: Results From the America Insomnia Survey.” JAMA Psychiatry 69(10)(October 2012):1054-63. Accessed April 6, 2018. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1370486. Spence, D. Warren, et al. “Acupuncture Increases Nocturnal Melatonin Secretion and Reduces Insomnia and Anxiety: A Preliminary Report.” Journal of Neuropsychiatry February 1, 2004. Accessed July 11, 2008. https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.16.1.19. Stoianovici, Robyn, Luigi Burnetti,

MDedge Psychiatry live Twitter chat on the aftermath of losing a patient to suicide. April 24th, 6 - 7 p.m. EST. @MDedgePsych, #MDedgeChats Episode 54 Donald Black, MD, gives a masterclass lecture on behavioral addictions and Renee Kohanski talks about what normal is.  Show Notes By Jacquiline Posada, MD. Gambling disorder (previously pathological gambling) is widespread, though not commonly assessed Patients may not volunteer information related to gambling unless asked, so questions about gambling should be included in routine questioning Assessment should include questions about legal and illegal gambling Explore extent: Ask about the level of financial burden; impact on home life, such as marital problems and divorce; legal complications like bankruptcy. Finally, ask about suicide risk related to gambling  Treatment: There is strong data for SSRI medications and naltrexone for urges Therapy is more efficacious, such as CBT therapy and Gamblers Anonymous  In certain states, such as Iowa, a person can ask for “self-exclusion,” which is essentially banning oneself from a casino or lottery. Also, participation in gambling results in arrest Behavioral addictions: Behavior that is out of control and has qualities and consequences similar to drug and alcohol addiction Examples include gambling disorder, compulsive buying, compulsive sexual behaviors (hypersexuality), and Internet addiction Gambling disorder is similar enough to substance addictions that it is included in the DSM-5 in the “substance-related and addictive disorder” Addiction neurocircuitry active in these behavioral addictions: Dopamine driven in the nucleus accumbens Compulsive shopping: primarily a female disorder, onset in late 20s, with shopping and spending that are chronic and problematic CBT programs developed to target compulsive shopping, studies about medications for this disorder are mixed Compulsive sexual behavior: Primarily a male disorder affecting 5% of the population; onset late teens, early 20s. The addiction will combine conventional sexual behaviors taken to extremes often combined with an addiction to pornography This disorder will often overlap with an Internet addiction No evidence-based treatments exist, though CBT-driven models and 12-step programs exist SSRI or TCA antidepressants may be helpful in dampening sex drive Internet addiction has developed in our technologically enabled world; most psychiatrists have encountered this addiction.  Most data come from Asia, where children are exposed to technology at an even earlier age than in the U.S. China has developed residential treatment programs involving individual and group therapies.  References Black DW. Can J Psychiatry. 2013 May;58(5):249-51. “Behavioral addictions as a way to classify behaviors” Dell’Osso B et al. Eur Arch Psychiatry Clin Neurosci. 2006 Dec;256(8):464-75. “Epidemiologic and clinical updates on impulse control disorders: a critical review” National Council on Problem Gambling. State by state help for problem gambling Zajac K et al. Psychol Addict Behav. 2017 Dec;31(8):979-94. “Treatments for Internet gaming disorder and Internet addiction: A systematic review”

Author: Michael Hunt, MD Educational Pearls: Valley fever is a fungal infection known as Coccidiomycosis that can present with vague symptoms like cough, fever, myalgias. A thorough history is critical to the diagnosis. Disease is localized to  the Southwestern US (California, New Mexico, Arizona, Nevada, Utah) and parts of Central/South America. Disease is caused by inhaling fungal spores which damage the lung. Rarely, the disease can disseminate and cause infections that require systemic anti fungal therapy.   References: Centers for Disease Control and Prevention (CDC). Increase in reported coccidioidomycosis--United States, 1998-2011. MMWR Morb Mortal Wkly Rep 2013; 62:217. Saubolle MA, McKellar PP, Sussland D. (2007). Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. Journal of Clinical Microbiology. 45:26. Taylor AB, Briney AK. (1949). Observations on primary coccidioidomycosis. Annals of Internal Medicine. 30:1224.

In this podcast, Associate Editor Jerrold Ward and author Cynthia Besch-Williford discuss her article "A Naturally Transmitted Epitheliotropic Polyomavirus Pathogenic in Immunodeficient Rats: Characterization, Transmission, and Preliminary Epidemiologic Studies" featured in the July 2017 issue of Toxicologic Pathology.    Click here to read the article. 

The most common primary brain tumor that occurs in adults, glioblastoma multiforme comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more how to improve the survival and the quality of life with patients who suffer from this terrible illness. Produced by James E. Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Grady, D “Glioblastoma, John Mccain’s Form of Brain Cancer, Carries Troubling Prognosis” The New York Times Scutti, S “Sen John McCain has aggressive brain tumor, surgically removed” CNN Gately L, et al. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv (2017). Thakkar JP, et al. Epidemiologic and Molecular Prognostic Review of Glioblastoma. Cancer epidemiology, biomarkers & prevention (2014). Louis DN, et al. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary” Acta Neuropathologica (2016) 6: 803-820. Stupp R, et al. MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma. N Engl J Med (2005). Stupp R, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology (2009). Weller M and Wick W. Neuro-oncology in 2013: improving outcome in newly diagnosed malignant glioma. Nature reviews Neurology. 2014;10:68-70.

Think of rhabdomyolysis and you'll think of an elevated creatine kinase (CK). The condition ranges from an asymptomatic period to a life-threatening condition with a hugely associated rise in CK which can also be accompanied by electrolyte disturbance, renal failure and disseminated intravascular coagulation. Rhabdomyolysis is caused by a breakdown in skeletal muscle and occurs most commonly following trauma, very often that can be due to a 'long-lie' when a patient is unable to get off a floor until help arrives after a prolonged period. There are other causes including drugs, muscle enzyme deficiencies, electrolyte abnormalities and more. The presentation itself is pretty vague and suspicion of the disease needs to be pretty high. Patients can experience weakness, myalgia and the dark'coca-cola urine', the diagnosis is then confirmed with a serum elevation in CK. The big concern with Rhabdomyolysis is the hit the kidneys take. Acute kidney injury is due to the heme pigment that is released from myoglobin and haemoglobin and is nephrotoxic. Early aggressive fluid rehydration aims to minimise ischaemic injury, increase urinary flow rates and thus limit intratubular cast formation. Fluids also help eliminate excess K+ that may be associated. But have a think about the management in your ED, how high does that CK need to be to require i.v. fluids and admission to hospital? Here's a few facts we need to know: Normal CK enzyme levels are 45–260 U/l. CK rises in rhabdomyolysis within 12hours of the onset of muscle injury CK levels peak at 1–3 days, and declines 3–5 days after muscle injury The peak CK level may be predictive of the development of renal failure A CK level of 5000 U/l or greater is related to renal failure Optimal fluid rate administration is unclear, some papers suggest replacement of isotonic saline at rates of 1-2L per hour. , adjusted to 200-300mL per hour to maintain a diuresis. Attention needs to be paid to urine output serum markers and fluid status. A lot of the evidence and knowledge surrounding rhabdomyolysis is from humanitarian disasters; earthquakes, terrorism along with observational cohorts, but at the end of the day we need to work with what we've got. Have a listen to the podcast and see what you think, the application of the evidence base may change your practice. Enjoy!  References Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians. Huerta-Alardín AL. Crit Care. 2005 Creatine kinase MB isoenzyme in dermatomyositis: a noncardiac source. Larca LJ. Ann Intern Med. 1981 Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective. Hatamizadeh P. Am J Kidney Dis. 2006   Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Mikkelsen TS. Acta Anaesthesiol Scand. 2005 Rhabdomyolysis: an evaluation of 475 hospitalized patients. Melli G. Medicine (Baltimore). 2005 Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. de Meijer AR. Intensive Care Med. 2003 Prevention and treatment of heme pigment-induced acute kidney injury (acute renal failure). Paul M Palevsky. UpToDate. 2015  

This episode we will be talking about Autism. Is it a vaccine injury? This weeks Newsletter: http://mmsnews.is/382-g2voice-018-autism-a-vaccine-injury-1-14-2017Autism Testimonies can be found in the newsletter link!DonationsG2voice donation button: http://genesis2church.is/donateHome Video CourseGenesis II Church Home Video course: http://www.genesis2church.is/courseReferences: Vaccine/Autism Connection I've Ever Heard! https://www.youtube.com/watch?v=o3P6wVUH0pcVaccine Fraud And "Herd Immunity" Explained: https://www.youtube.com/watch?v=rf1V0rpHsiA• Dr. Mercola and Barbara Loe Fisher - Herd Immunityhttps://www.youtube.com/watch?v=TFWBelim1Hw&t=297s• Vaccine Herd Immunity Lie Exposed https://www.youtube.com/watch?v=3RUeOxvvZfI• Expert Pediatrician Discusses Herd Immunity: https://www.youtube.com/watch?v=v_iU7aEVTgU• Dr. Tenpenny discusses why herd immunity doesn't apply to vaccines and more 
https://www.youtube.com/watch?v=vmZPwJTtak0 • Epidemiologic and Molecular Relationship Between Vaccine Manufacture and Autism Spectrum Disorder Prevalence. https://www.ncbi.nlm.nih.gov/pubmed/26103708/ • Vaccine Fraud And "Herd Immunity" Explained https://www.youtube.com/watch?v=rf1V0rpHsiA• Dr. Mercola and Barbara Loe Fisher - Herd Immunityhttps://www.youtube.com/watch?v=TFWBelim1Hw&t=297s• Vaccine Herd Immunity Lie Exposed https://www.youtube.com/watch?v=3RUeOxvvZfI• Expert Pediatrician Discusses Herd Immunity: https://www.youtube.com/watch?v=v_iU7aEVTgU• Dr. Tenpenny discusses why herd immunity doesn't apply to vaccines and more
https://www.youtube.com/watch?v=vmZPwJTtak0 • 7 reasons CDC employees should be “crying in the hallways” https://medium.com/@jbhandley/7-reasons-cdc-employees-should-be-crying-in-the-hallways-55dd2dc32124#.3uo10sim3• HORRORS OF VACCINATION BY Dr. Schieferdecker 1870 Dr. Collins, twenty years vaccine physician in London and Edinburgh, writes “ There really exists no  change in the virulent character of the small-pox notwithstanding the vaccination-laws; and of those attacked by the disease at the least two-thirds were satisfactorily vaccinated.” He adds: If I had the desire to describe one-third of the victims ruined by vaccination, the blood would stand still in your veins. I have not the least confidence in vaccination; it nauseates me, for it transfers often filthy and dangerous diseases from one to another, without offering any protection whatever.”https://ia600800.us.archive.org/15/items/39002086344398.
med.yale.edu/39002086344398.med.yale.edu.pdf

Don bravely did this podcast without a microphone boom. Ben feels good despite his messy office. Ben mentions that he is currently obsessed with the Rolling Stones and likes the Shine a Light Film, Jumpin’ Jack Flash, (the song not so much the Whoopi Goldberg spy comedy film), and the song Salt of the Earth from the Stones album Beggars Banquet. They then discuss movies every kid needs to see before they turn thirteen such as Indiana Jones, Ghostbusters, E.T., and Diary of a Wimpy Kid and classic kids books including The Hardy Boys, Encyclopedia Brown, Three Investigators, Key to the Treasure, and A Wrinkle in Time. The guys then discuss their recovery after IAFP, as a follow-up to FST 66. As president of IAFP Don was very busy at the conference with meetings, breakfasts, committee responsibilities, and other assorted duties. He made the conference manageable by shirking his student poster responsibilities, not going to any talks, and skipping PDG meetings. He did however give a talk on based on a paper he has been working on with his CDC and EHS-Net (pronounced S-net) colleagues. The guys then drift to other podcasts, especially Alton Brown’s series and in particular one he did with William Shatner. If you like podcasts, food, Alton Brown, or William Shatner, this stupendous podcast is highly recommended for you. Thirty-five minutes in they decide that they should talk about food safety and get to Outbreak Flashback about a 2008 Salmonella Saintpaul outbreak that affected over 1400 nationally (as per Michelle Danyluk's suggestion. Initial CDC epidemiology analysis indicated the illnesses were associated with eating tomato dishes and FDA issued a health advisory on tomatoes. This NEJM article shows the case control studies that layout why the CDC initially thought the source was tomatoes. After tomatoes were removed from the market the illness continued and with additional data available the CDC later concluded that jalapeño and Serrano peppers were the likely source. Epidemiologic analysis was confounded by the fact that many illnesses were from restaurants where peppers were in dishes that contained multiple ingredients. Additionally the production and supply chain was very complex as is shown in the FDA’s traceback diagram. A key aspect of this outbreak is that it significantly harmed reputation and sales of the tomato industry, which estimates $400 million lost dollars as a result of the FDA’s erroneous health advisory. Talk turned to growers seeking indemnification or financial compensation for situations when the government agencies are incorrect about outbreaks. The guys then discuss a voluntary recall by Wawona Packing Co. on fresh peaches and stone fruit. A receiving company in Australia detected the presence of Listeria monocytogenes. This later led to a recall of baked goods in Wegman’s supermarket chain presumably because Wegman’s baking process is not validated. There are a surprisingly high number of comments posted to the Wegman’s article in Food Safety News which caused the guys to consider if the public health implications of this recall are more significant than first thought. For Listeria monocytogenes (LM) there are not a lot of outbreaks but rather sporadic cases; CDC estimates in 2013 there were 0.26 LM illness cases per 100,000 people in the US (for every case reported there are 2 cases not diagnosed). The guys then discuss food safety gaps common in fresh produce including poorly executed washing processes and traceability deficiencies. In after dark the guys discuss that Dean Richard Linton, Dean of the NCSU College of Ag, has selected the 2014 Dean’s ice cream which is dark chocolate, tart cherries, chocolate chunks and marshmallow swirl.

JAACAP May 2014: Contributing Editor Dr. Natalie Weder interviews Dr. Young Shin Kim on changes in autism diagnostic criteria found in the DSM-5.

JAACAP May 2014: Contributing Editor Dr. Natalie Weder interviews Dr. Young Shin Kim on changes in autism diagnostic criteria found in the DSM-5.

  Episode 6: Diet Recommendations   Many choices in pet foods Dizzying array in the pet store from the least expensive to the more expensive and ‘holistic' foods What is a ‘holistic' food?   Which one to choose? Why? Two primary concerns: Nutritional quality Safety   Recent safety concerns with commercial foods – What's in the bag?: Melamine Aflatoxin or other fungal toxins Pentobarbital or other drug residues 2002 FDA veterinarian Newsletter Vol XVI, No III http://www.fda.gov/AnimalVeterinary/NewsEvents/FDAVeterinarianNewsletter/ucm110419.htm “After finding that the low levels of pentobarbital that dogs might receive through food are unlikely to cause them any adverse health effects, FDA officials did not think that further research into the issue was necessary.” Bacterial contaminants Human Salmonella Infections Linked to Contaminated Dry Dog and Cat Food, 2006-2008 Seventy-nine case-patients in 21 states were identified; 48% were children aged 2 years or younger. A low attack rate supports the hypothesis that infection might have resulted from practices in a limited number of households. One possibility is that the number of organisms was magnified in some households because of, eg, cross contamination in the kitchens or irregular cleaning of pet food bowls, which might promote bacteria growth. In addition, illness may have occurred primarily in persons who were more susceptible to infection with a small number of organisms. Illness was not reported in dogs or cats from case patient households, although the outbreak strain was cultured from several stool specimens from dogs who ate contaminated dry dog food. Some children may have become ill from contact with a pet carrying the outbreak strain. Prevalence of isolation of Salmonella from feces of healthy dogs is reported to be between 1% and 36%, and from healthy cats between 1% and 18%. Dogs and cats may shed Salmonella in the feces for as long as 12 weeks, and shedding may be intermittent, 11 so the risk of infection could continue for extended periods. In addition, it is thought that Salmonella can survive for extended periods in dry dog and cat food, as it can in similar dried foods such as cereals. Forty-three million US households (37%) own dogs and 37.5 million (32%) own cats, and many pet owners feed the animals dry pet food. …dry pet food, the most common pet food fed to dogs and cats, is not manufactured to be a sterile product. Typically, a more drastic heat treatment is required to destroy Salmonella in dried food products. Since 2006, according to the FDA, at least 13 recall announcements involving 135 pet products (eg, dry dog food and cat food, pet treats, raw diets, and pet supplements) have been issued because of Salmonella contamination.  No human illness was associated with these other pet food recalls. The recommendation to wash hands is the most important prevention step for reducing the risk for disease transmission. {http://pediatrics.aappublications.org/content/early/2010/08/09/peds.2009-3273.full.pdf } http://www.dogfoodadvisor.com/dog-food-recalls/ A total of 49 individuals (47 individuals in 20 states and two individuals in Canada) infected with the outbreak strain of Salmonella Infantis were reported. Among the 24 patients with available information, 10 (42%) were hospitalized. No deaths have been reported. Epidemiologic and laboratory investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to dry dog food produced by Diamond Pet Foods at a single production facility in Gaston, South Carolina. Multistate Outbreak of Human Salmonella Infantis Infections Linked to Dry Dog Food (Final Update) http://www.cdc.gov/salmonella/dog-food-05-12/pet-owners-info.html Salmonella Infection (salmonellosis) and Animals

Sudden cardiac death (SCD) is an unresolved health issue, and responsible for 15% of all deaths in Western countries. Epidemiologic evidence, as well as evidence from clinical trials, indicates that increasing intake and high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) protect from SCD and other major adverse cardiac events. Levels of EPA+DHA are best assessed by the Omega-3 Index, representing the red cell fatty acid content of EPA+DHA. Work is in progress that will further define the value of the Omega- 3 Index as a risk factor for SCD, other cardiac events, and as target for treatment with EPA+DHA.