Podcasts about nurses health study

Du möchtest gesund alt werden? Dann solltest du viele Proteine essen. Zu diesem Ergebnis kommt eine aktuelle Studie. Welche genau und weitere Einzelheiten erfährst du in dieser Podcastfolge. Studie: Ardisson Korat, A. V., Shea, M. K., Jacques, P. F., Sebastiani, P., Wang, M., Eliassen, A. H., Willett, W. C., & Sun, Q. (2024). Dietary protein intake in midlife in relation to healthy aging – results from the prospective Nurses‘ Health Study cohort. The American Journal of Clinical Nutrition, 119(2), 271–282. https://doi.org/10.1016/j.ajcnut.2023.11.010 Hier kannst du dich auf die Warteliste für den großen vollundwertig Kurs setzen: https://vollundwertig.de/kurs-warteliste/ Wenn dir der Podcast gefällt, hinterlasse mir eine Bewertung bei Spotify oder Apple Podcasts. Damit unterstützt du mich sehr. Für mehr fundiertes Ernährungs- und Einkaufswissen und alles rund um eine vollwertig, pflanzliche(re) Ernährung folge mir bei Instagram: https://www.instagram.com/vollundwertig/

Research about menopause right now is finally beginning to really get its moment. Or is it? What's something you can trust? And what's stated as “science-based” or “science-backed”? What can you trust and what should you question? Think of this as a crash course in Research 101. In fact, I think that was a required course my first semester in grad school. The content is as important or more today when you have influencers talking about studies, in fact sponsoring their own to back up their products. You see both experts and influencers on line and are left to sort out one from the other yourself. Questions We Answer in this Episode: How to know if a source is credible? [00:36:00] What determines a peer-reviewed journal? [00:18:50] Are all studies on PubMed or Science Direct peer-reviewed? [00:36:00] Are all studies from Google Scholar (AI) peer-reviewed? [00:37:00] What makes some research studies better than others? [00:04:50] In short this will be a bit like a vocabulary lesson so you can filter news regarding research about menopause for yourself. The  spoiler alert is this: the gold standard in health research are those that are interventional, randomized, double-blind, placebo-controlled studies. In the planning stages and then results and discussion these things will be considered and determined: Reliability is at least 3 independent experiments giving the same results. Relevant to you with subjects just like you. Recency is often within the last 10 years with exception Validity is about how well findings apply to those not in the study. (discussion is about communicating things that may interfere with it being applicable to a diagnosis or a protocol or treatment) Confidence level aiming at 95% confidence level requires a result across a large number of subjects to show it Sample size A good maximum sample size is often around 10% of the population, as long as it doesn't exceed 1,000 people. At least 100 subjects. Larger than 30, less than 500. The answers vary considerably. What you should expect: Written for professionals Authors names and a contact included Bibliography included Peer-reviewed journal How do you know if it's a peer-reviewed journal? Go to the journal (not the article to find out). The journal website includes information for authors about the publication process. A board of experts review and evaluate before acceptance for publication in peer-reviewed journals. Two Additional Terms to Know Regarding Research About Menopause Qualitative - descriptive is more loosely gathered data that might be polls or surveys and interpreting the responses without giving a percentage. This might also come from a review of literature which isn't actually conducting a study but is reviewing a pool of studies to seek common denominators about the research methods and results. Quantitative - based on numbers and is going to result in for instance a percent of muscle lost on average each decade, or over 80% of women describe libido issues. Mixed -  including both There are many types of studies starting with observational and interventional. Observational studies look at what effects habits, beliefs or events affect certain outcomes. For instance, a study that reported an association between increased meat eating and cancer. However, the study was conducted based on a survey where participation was compensated. Participants in such studies may be motivated by the ease of collecting $20 for reporting their habits but might be consuming hot dogs and bologna and Spam, unlike you who are choosing other options that are organic, grass-fed and finished wild options. The headlines? Satisfy a great need by the media to get views, clicks and engagement. Interventional studies, just as it sounds, provide some kind of imposed change to subjects. For instance, providing an example on research about menopause, a study published in Obesity on post menopausal women in a weight loss program divided groups into long sleepers vs short sleepers. They compared results from the change in sleep while other conditions (eating and exercise) were controlled. Though this may not fall directly under current research about menopause, a recently published study in JAMA in July 2024 found older adults (av age 71) who lifted heavy weights for 1 year retained their strength for 4 years while those doing moderate weight training did not. This was a randomized longitudinal study. Types of Research About Menopause Longitudinal vs Cross sectional Looking at the same co-hort over time checking in periodically to see what results occur vs look at different segments of the population one time. In research about menopause, perhaps none is more well-known than The Nurses Health Study. It is a longitudinal observational study looking at the effects of certain habits over time. Some of Dr Loren Fishman's studies on 12 yoga poses have been longitudinal studies showing increase in bone density over time. Some also were retrospective looking back at what happened in women who had done yoga more than every other day. New studies that would take specific poses and see which of those were most beneficial would be prospective, or  going forward in time. Active treatment vs placebo studies are where all receive the treatment vs some subjects receive the actual drug or treatment and others receive a placebo sugar pill. Sometimes this is an exercise intervention. Where the actual protocol tested is resistance training exercise and the placebo also does resistance training but without protocol Control group means that a subset group does not have the treatment or follow protocol. For instance in Fishman's studies an experimental group would have done the yoga poses and a control group was also post menopausal but did not do the yoga poses. Open vs Blind/Double Blind: everyone knows who is in which group (experimental, placebo or control) vs subjects or researchers don't know vs neither researchers nor subjects know which is which. Randomized control vs case control References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188693/#:~:text=The validity of a research,associations%2C interventions%2C and diagnosis. https://jamanetwork.com/journals/jama/article-abstract/2821225 Other Episodes You Might Like: Living Longer is NOT the Goal: Research on Longevity: https://www.flippingfifty.com/living-longer/ Science that Makes Exercise Essential for Menopause Health: https://www.flippingfifty.com/exercise-essential-for-menopause-health/ Boost Weight Loss with Exercise and Eating Timing: Science Studies: https://www.flippingfifty.com/boost-weight-loss-with-exercise-and-eating-timing-science-studies/ Resources: Hot Not Bothered Challenge: https://www.flippingfifty.com/hot-not-bothered-challenge-2023/ Stronger: https://www.flippingfifty.com/get-stronger/

Show Notes: Julie Lin was a medical student at Columbia's College of Physicians and Surgeons when she met her future husband. It was the first day of medical school and they met while attending a class where they were both serious amateur classical musicians. Julie talks about their shared love of music and how they planned to have a family quartet.  The All-state Orchestra Model Julie shares her story of starting an orchestra at medical school, which initially had a traditional weekly rehearsal and concert. However, they found that the show rate was low as exam time approached, leading to the creation of the Allstate orchestra model. This model involved distributing music and parts ahead of time, having a three or four-hour rehearsal, and playing in front of an invited live audience. Experiences at Medical School  Julie initially thought she would be a clinician, but during her nephrology fellowship program, she trains to become a specialist in kidney medicine, she also became interested in clinical research. This realization led her to pursue academic nephrology, which was life-changing for her. After her husband's residency and postdoctoral training in Boston, Julie started working as an instructor at Harvard Medical School and attending physician at Brigham and Women's Hospital. As part of her job offer, she negotiated for funding from the nephrology division to obtain a Master's in Public Health from Harvard, focusing on quantitative analysis rather than policy. Working in Nephrology Research Julie worked as an investigator in the Channing laboratory at Brigham and Women's Harvard, where they had ongoing cohort studies of health professionals for over 10 years. She was one of the many NIH-funded investigators in the Nurses Health Study, a cohort study of  >120,000 US nurses who signed up in 1976. A subset of women in the study had submitted blood and urine samples, which allowed for analyses of  change in estimated kidney function over 11 years between 1989 and 2000.   Kidney Function Decline Research  Julie's research included looking at diet, nutrients, foods, and dietary patterns and how they impacted kidney function and change. Work that gained the most media attention was diet work. Her research found that drinking two or more servings of artificially sweetened drinks, likely soda, was associated with a faster kidney function decline in women over 11 years. This was about three times faster than normal aging alone. The researchers adjusted for factors like diabetes and high blood pressure, which are big risk factors for kidney function loss. Julie also talks about research on the Mediterranean diet vs. Western dietary patterns.  Diet for Kidney Health The conversation turns to the concept of the blue zone, which has been associated with longevity and longevity, but that many people living over 100 years in these areas may have exaggerated their age due to poor record keeping. This leads Julie to remark that a main concern for scientists is how well information is being captured and measured.  Julie shares tips on the best diet for kidney health. Low sugar intake is recommended, as it can lead to weight gain and diabetes. Vegetarian diets are also healthy, and fish is recommended as the main source of animal protein. A Clinical Research Career in Industry Julie talks about the reduction in academic research funding, and why she decided to continue her clinical research career in industry, working on clinical trials and developing new drugs. She has worked with Amgen, Genzyme, a rare disease company, as well as at a gene therapy startup called Dimension Therapeutics, which was acquired by Ultragenyx. Her current role is as global project head at Sanofi. She talks about her role and the importance of assessing efficacy and safety of new therapies. Playing in Community Orchestras and Chamber Music Julie explains that, as an amateur musician, she has found it to be a great outlet for her stress and the intense work she had to do while working and taking care of her children when they were younger. She joined a community orchestra in 2012,  since then she has played in a number of community orchestras, including New Philharmonia, Longwood, and Brookline Symphony. Julie has also played with the Mercury Orchestra, founded and conducted by Channing Yu, Class of 93. Recently, she decided to focus on chamber music, which has been her true love. She has a lot of local musician friends to play with. Julie explains that playing chamber music brings a sense of flow and connection to others, making it a great gift.  Influential Harvard Professors and Courses Julie shares her experiences in Harvard's music 180 class, taught by Leon Kirchner and Lynn Chang, which was an intense experience. She also recalls a class where a modern and atonal piece was played by an advanced violinist, which changed her view of Schoenberg's music. She also mentions Helen Vendler's poetry class. Timestamps: 05:38 Medical school experiences, including a non-linear podcast format and a successful orchestra performance 09:30 Career paths in medicine, including becoming a physician scientist, with insights on negotiation for benefits and research in nephrology  16:31 Diet and kidney function, with findings on artificial sweetened drinks and Mediterranean diet 21:17 Aging, nutrition, and kidney health with a former academic researcher turned pharmaceutical industry professional 28:36 Musical experiences and focus on chamber music 33:01 Music, Harvard, and the importance of flow Links: LinkedIn: https://www.linkedin.com/in/julie-lin-md-mph-fasn-71796b2a/   Featured Non-profit The featured non-profit of this episode is Esperanza Shelter, recommended by Caribou Honig who reports “Hi, I'm Caribou Honig, class of 1992. The featured nonprofit of this episode of The 92 report is Esperanza shelter. The shelter does incredibly important work, enabling people and very importantly, their children, to escape abusive relationships throughout northern New Mexico. Equally important, is that they provide a wide range of services to help those survivors get back on their feet, providing everything from emergency shelter to transitional housing to counseling and life skills. My wife and I have been donating to Esperanza shelter since 2020. You can learn more about their work at Esperanza shelter.org. Esperanza for those of you not in the know is the Spanish word for hope. And now here's Will Bachman with this week's episode. To learn more about their work, visit https://esperanzashelter.org/.

In This Episode, You Will Learn: Advice and helpful resources for cancer prevention. How to form healthy habits for a healthy lifestyle. Tips for night shift nurses, new grads, and nurses interested in non-bedside jobs. Resources + Links: Follow Becky on Instagram | @rstrn   Get involved at https://nurseshealthstudy.org/   Learn more about cancer prevention at https://www.aicr.org/   Check out these other organizations, studies, and resources: American Cancer Society: www.cancer.org for screening information Oncology Nursing Society: www.ons.org for navigator resources and core competencies!  Nurses Health Study: https://nurseshealthstudy.org/  Lots of publications from their data on the site. Here is a link to join the new study: https://www.nhs3.org/   Indeed.com also has some good resources for helping evaluate/thinking through next steps in finding a job you'll enjoy.   Check out these articles: Center for Disease Control and Prevention:  Night shift and cancer risk https://blogs.cdc.gov/niosh-science-blog/2021/04/27/nightshift-cancer/   Moving past fear, Donna Cardillo: https://donnacardillo.com/articles/movingpastfear/  Connect with us on Instagram | @lifeinscrubspodcast   Follow along with our personal Instagram pages too!   Connect with Kristen on Instagram | @thenursekristen  Connect with Maddi on Instagram | @nurse.maddi  Show Notes: How can we create and promote healthier lifestyles? This week we have a new guest joining us: Becky Trupp, an oncology nurse navigator from the Seville Cancer Screening and Prevention Center! With 32 years of experience under her belt, Becky will share her wisdom on cancer prevention and healthy living for nurses just like you. We'll cover what you need to know about cancer prevention so you can help keep yourself and your loved ones safe. Then, we'll go over useful tips for night shift nurses to look out for, as well as advice for those interested in getting involved in non-bedside jobs. We've got your key to a healthier future right here! 00:40 Meet Becky Trupp, an oncology nurse navigator from the Seville Cancer Screening and Prevention Center! 01:30 How did you get to where you are today? 04:20 Opening yourself up to new possibilities. 07:30 Where did you go after you were let go from your high risk job? 09:10 How have your experiences with past jobs helped you in the present? 10:15 What do you do at your center? 11:15 What do you think is most important for nurses to know about cancer prevention? 14:50 How does working the night shift affect nurses? 16:35 What are some resources you recommend for nurses? 18:10 What tips do you have for night shift nurses to take care of themselves? 20:55 Forming small habits to create big changes in your lifestyle. 24:15 How can someone get involved in more non-bedside jobs? 27:20 Would you recommend a new grad have experience before going into a nurse navigation position? 31:25 Where can people look for more information on cancer prevention?

Monologue Dr. Joel Wallach begins the show today discussing the COVID 19 numbers of infections and deaths. Comparing the U.S. numbers to other countries. Asserting these other countries have a lot less numbers of infections and deaths. Because these peoples don't eat gluten. Contending gluten kills the bone marrow where white blood cells and platelets are grown. Pearls of Wisdom Researchers looked at the diets of nearly 34,000 women as part of the Nurses Health Study. Asking them about their diets and lifestyles and following them for four years. Those with sound mental health and no chronic diseases were deemed "healthy agers". Finding those who ate at least two servings of walnuts a week were more likely to be "healthy agers" those who didn't eat walnuts. Callers Murry is obese and has concerns over blood in his stool. Mark is experiencing chronic joint pain. Tim has a testimonial about how well his pats have done taking the Arthrydex product. Dale has a friend that suffered an anuerysm. Paul has chronic foot pain. Call Dr. Wallach's live radio program weekdays from noon until 1pm pacific time at 831-685-1080 or toll free at 888-379-2552.

  Vidcast:  https://youtu.be/zOJBaUruPCY   Young women consuming more than two servings a day of sugar-sweetened drinks more than double their risk (2.2) of bowel cancer.  Public health researchers at St. Louis’ Washington University issue this warning after comparing the dietary records of 95,464 women participating in the Nurses’ Health Study.   The cancer risk escalates 16% for every extra sugary drink serving/day.  That risk doubles to 32% for those consuming an extra beverage during their teen years.   Conversely, eliminating that sugary drink in favor of coffee, milk, or diet drinks reduces the colon cancer risk from 17-36%.   Your bowels may not tolerate sugar well, but colon cancer feeds off it.   https://gut.bmj.com/content/early/2021/05/09/gutjnl-2020-323450   #cancer #sugar #softdrinks #colon  

A new effect of red ginseng: suppression of lung cancer metastasis KIST Gangneung Institute (South Korea), March 3, 2021 Red ginseng, which has long been used as an ingredient in traditional Korean medicine, has recently drawn increased attention as a functional material for its health-promoting effects. The composition and activities of red ginseng vary depending on the processing method, and this has become an active area of research. Recently, a research team in Korea has entered the spotlight as they discovered that red ginseng has inhibitory effects against lung cancer metastasis. The Korea Institute of Science and Technology (KIST) reported that a joint study conducted by Dr. Jungyeob Ham from the Natural Product Research Center at the KIST Gangneung Institute of Natural Products and Dr. Hyeonseok Ko of Seoul Asan Medical Center revealed that two components of red ginseng, Rk1 and Rg5, can significantly suppress lung cancer metastasis. Dr. Ham of KIST developed a new microwave processing method for red ginseng that is based on the same principle as a microwave oven, which when compared to existing processing methods, such as repetitive steaming and drying, increases the concentration of the three main active components, Rg3, Rk1, and Rg5, more than 20 times. The research team previously demonstrated that red ginseng produced by this microwave processing method, which they have called KMxG, is effective against prostate, cervical, and skin cancers, and has protective effects against by drug-induced kidney damage. This technology was transferred to Ponin Bio Co., Ltd. in 2020 for a technology fee of KRW 800 million and is currently being developed for commercialization. Unlike normal cells, which die when separated from their original tissue, cancer cells can spread to other tissues where they invade and grow, in a process called metastasis. TGF-β1, a cytokine protein that functions as a signaling substance in the body, induces lung cancer metastasis and promotes the development of stem cell-like properties in cancer cells. The KIST research team treated lung cancer cells with Rk1 and Rg5, the main components of KMxG red ginseng and showed that both components effectively inhibited various processes related to cancer metastasis induced by TGF-β1. "Although components of red ginseng previously have been shown to kill cancer cells, this study proved that these components of red ginseng have other anti-cancer effects and can inhibit lung cancer metastasis. This provides scientific evidence that may lead to the future development of anti-cancer drugs derived from natural products," remarked Dr. Ham. He added, "Because we can control the active ingredient contents of red ginseng by using microwave processing methods like the one that produced KMxG, it may be possible to develop customized functional materials for various diseases."   Intermittent fasting promotes anti-anxiety effects Federal University of Porto Alegre (Brazil), February 28, 2021 According to news reporting originating from Porto Alegre, Brazil, research stated, “Anxiety disorders are linked to mitochondrial dysfunction and decreased neurotrophic support. Since anxiolytic drugs target mitochondria, non-pharmacological approaches to improve mitochondrial metabolism such as intermittent fasting (IF) may cause parallel behavioral benefits against anxiety disorders.” Our news editors obtained a quote from the research from Federal University, “Here, we investigated whether a chronic IF regimen could induce anxiolytic-like effects concomitantly to modulation in mitochondrial bioenergetics and trophic signaling in mice brain. A total of 44 Male C57BL/6 J mice (180 days old) were assigned to two dietary regimens: a normal, ad libitum diet (AL group) and an alternate-day fasting (IF group), where animals underwent 10 cycles of 24 h food restriction followed by 24 h ad libitum access. Animals underwent the open field test, dark/light box and elevated plus maze tasks. Isolated nerve terminals were obtained from mice brain and used for mitochondrial respirometry, hydrogen peroxide production and assessment of membrane potential dynamics, calcium handling and western blotting. We showed that IF significantly alters total daily food intake and food consumption patterns but not body weight. There were no differences in the exploratory and locomotory parameters. Remarkably, animals from IF showed decreased anxiety-like behavior. Mitochondrial metabolic responses in different coupling states and parameters linked with HO production, Ca buffering and electric gradient were not different between groups. Finally, no alterations in molecular indicators of apoptotic death (Bax/Bcl-2 ratio) and neuroplasticity (proBDNF/BDNF and synaptophysin were observed).” According to the news editors, the research concluded: “IF exerts anxiolytic-like effect not associated with modulation in synaptic neuronergetics or expression of neurotrophic proteins. These results highlight a potential benefit of intermittent fasting as a nutritional intervention in anxiety-related disorders.” This research has been peer-reviewed.     Moderate-to-vigorous physical activity and less sitting reduce the risk of diabetes in older adults University of Oulu (Finland), February 26, 2021 According to a recent study, moderate-to-vigorous physical activity and less sedentary time improve glucose metabolism and reduce the risk of type 2 diabetes in older adults. Based on the results, it is important to encourage older adults to avoid sedentary time and increase moderate-to-vigorous physical activity to improve their glucose metabolism. The study is part of the population-based Oulu1945 survey conducted in 2013–2015 by the University of Oulu and Oulu Deaconess Institute's Department of Sports and Exercise Medicine, Finland. The survey involved a total of 660 Oulu residents born in 1945 and between the ages of 67 and 69, at that time. Physical activity and sedentary time were measured with a wrist-worn accelerometer for a period of two weeks, and the glucose metabolism was examined using an oral glucose tolerance test. The subjects were divided into the following four profiles based on the amount of moderate-to-vigorous physical activity and sedentary time: "couch potatoes," "light movers," "sedentary actives" and "actives." "Active" older adults had a lower incidence of type 2 diabetes and prediabetes than older adults in the 'couch potatoes' profile, one in two of whom were found to have a glucose metabolism disorder. The blood glucose and insulin concentrations in the 'active' profile were lower throughout the glucose tolerance test compared to those in the less physically active groups. Older adults in the 'active' profile had a better glucose tolerance and muscle insulin sensitivity than those in the 'couch potatoes' profile, both clear signs of a reduced risk of diabetes. "Previous surveys have suggested a link between older adults' physical activity and glucose metabolism, but the use of the accelerometer in studies involving older adults has been negligible. In this study, we were able to make a distinction between moderate-to-vigorous physical activity and sedentary time through accelerometry and to then profile the subjects on that basis in different activity profiles. We analyzed the association between the physical activity profile and glucose metabolism, which is a new perspective. By the activity profiles, we can see that, from the point of view of glucose metabolism, physical activity alone is not enough: you should be active and potter about throughout the day," says researcher Miia Länsitie. The risk of glucose metabolism disorders increases significantly in older age, making it essential to find ways to prevent diabetes in older adults. Based on this study, an active lifestyle, including moderate-to-vigorous physical activity and limited sedentary time, also promotes older adults' glucose metabolism and can play a significant role in preventing diabetes in older people. "Older adults with long-term illnesses or functional limitations, who may find it impossible to achieve the recommended level of physical activity, should spend less time sitting down and more pottering about every day to enhance their glucose metabolism," Länsitie says.   The right '5-a-day' mix is 2 fruit and 3 vegetable servings for longer life Harvard Medical School, March 1, 2021  Studies representing nearly 2 million adults worldwide show that eating about five daily servings of fruits and vegetables, in which 2 are fruits and 3 are vegetables, is likely the optimal amount for a longer life, according to new research published today in the American Heart Association’s flagship journal Circulation. Diets rich in fruits and vegetables help reduce risk for numerous chronic health conditions that are leading causes of death, including cardiovascular disease and cancer. Yet, only about one in 10 adults eat enough fruits or vegetables, according to the U.S. Centers for Disease Control and Prevention. “While groups like the American Heart Association recommend four to five servings each of fruits and vegetables daily, consumers likely get inconsistent messages about what defines optimal daily intake of fruits and vegetables such as the recommended amount, and which foods to include and avoid,” said lead study author Dong D. Wang, M.D., Sc.D., an epidemiologist, nutritionist and a member of the medical faculty at Harvard Medical School and Brigham and Women’s Hospital in Boston. Wang and colleagues analyzed data from the Nurses’ Health Study and the Health Professionals Follow-Up Study, two studies including more than 100,000 adults who were followed for up to 30 years. Both datasets included detailed dietary information repeatedly collected every two to four years. For this analysis, researchers also pooled data on fruit and vegetable intake and death from 26 studies that included about 1.9 million participants from 29 countries and territories in North and South America, Europe, Asia, Africa and Australia. Analysis of all studies, with a composite of more than 2 million participants, revealed: Intake of about five servings of fruits and vegetables daily was associated with the lowest risk of death. Eating more than five servings was not associated with additional benefit.  Eating about two servings daily of fruits and three servings daily of vegetables was associated with the greatest longevity. Compared to those who consumed two servings of fruit and vegetables per day, participants who consumed five servings a day of fruits and vegetable had a 13% lower risk of death from all causes; a 12% lower risk of death from cardiovascular disease, including heart disease and stroke; a 10% lower risk of death from cancer; and a 35% lower risk of death from respiratory disease, such as chronic obstructive pulmonary disease (COPD). Not all foods that one might consider to be fruits and vegetables offered the same benefits. For example: Starchy vegetables, such as peas and corn, fruit juices and potatoes were not associated with reduced risk of death from all causes or specific chronic diseases. On the other hand, green leafy vegetables, including spinach, lettuce and kale, and fruit and vegetables rich in beta carotene and vitamin C, such as citrus fruits, berries and carrots, showed benefits. “Our analysis in the two cohorts of U.S. men and women yielded results similar to those from 26 cohorts around the world, which supports the biological plausibility of our findings and suggests these findings can be applied to broader populations,” Wang said. Wang said this study identifies an optimal intake level of fruits and vegetables and supports the evidence-based, succinct public health message of ‘5-a-day,’ meaning people should ideally consume five servings of fruit and vegetable each day. “This amount likely offers the most benefit in terms of prevention of major chronic disease and is a relatively achievable intake for the general public,” he said. “We also found that not all fruits and vegetables offer the same degree of benefit, even though current dietary recommendations generally treat all types of fruits and vegetables, including starchy vegetables, fruit juices and potatoes, the same.” A limitation of the research is that it is observational, showing an association between fruit and vegetable consumption and risk of death; it does not confer a direct cause-and-effect relationship. “The American Heart Association recommends filling at least half your plate with fruits and vegetables at each meal,” said Anne Thorndike, M.D., M.P.H., chair of the American Heart Association’s nutrition committee and an associate professor of medicine at Harvard Medical School in Boston. “This research provides strong evidence for the lifelong benefits of eating fruits and vegetables and suggests a goal amount to consume daily for ideal health. Fruits and vegetables are naturally packaged sources of nutrients that can be included in most meals and snacks, and they are essential for keeping our hearts and bodies healthy.”   Mechanisms through which melatonin prevents osteoporosis explore Natural Science Foundation of Liaoning Province (China), February 26, 2021 According to news reporting from Liaoning, People’s Republic of China, research stated, “Melatonin, secreted in a typical diurnal rhythm pattern, has been reported to prevent osteoporosis; however, its role in osteoclastogenesis remains unclear. In the present study, the ability of melatonin to inhibit receptor activator of nuclear factor-kappa B ligand (RANKL)-induced osteoclastogenesis and the associated mechanism were investigated.” The news correspondents obtained a quote from the research from China Medical University, “Raw264.7 cells were cultured with RANKL (100 ng/ml) and macrophage colony-stimulating factor (M-CSF; 30 ng/ml) for 7 days, and tartrate-resistant acid phosphatase (TRAP) staining was used to detect osteoclastogenesis following treatment with melatonin. In addition, the effect of melatonin on cathepsin K and microRNA (miR)-882 expression was investigated via western blotting and reverse transcription-quantitative PCR. Melatonin significantly inhibited RANKL-induced osteoclastogenesis in Raw264.7 cells. From bioinformatics analysis, it was inferred that nuclear receptor subfamily 1 group D member 1 (NR1D1/Rev-erb alpha) may be a target of miR-882. In vitro, melatonin upregulated Rev-erb alpha expression and downregulated miR-882 expression in the osteoclastogenesis model. Rev-erb alpha overexpression boosted the anti-osteoclastogenesis effects of melatonin, whereas miR-882 partially diminished these effects.” According to the news reporters, the research concluded: “The present results indicated that the miR-882/Rev-erb alpha axis may serve a vital role in inhibiting osteoclastogenesis following RANKL and M-CSF treatment, indicating that Rev-erb alpha agonism or miR-882 inhibition may represent mechanisms through which melatonin prevents osteoporosis.” This research has been peer-reviewed.     Rhythm Of Breathing Key To Controlling Fear And Emotional Behavior Northwestern University, March 2, 2021    We live in a fearful world with exposure to a deluge of stressors every day. As much as fear is a result of reacting to the actual or perceived events in our lives, it is also a biological function of the human body, and when equipped with an understanding of how the body manages the emotional system, we can easily outsmart it, tricking ourselves into emotional balance. This perspective is scientifically validated by new research from Northwestern University Feinberg School of Medicine in Chicago Illinois, which discovered how the various rhythmic patterns of breath profoundly impact memory recall and the emotional body, specifically the fear response.   The brain creates electrical impulses which link physical functions to emotional reactions, and the electrical activity of the brain is deeply affected by our breathing patterns. The outcome of this balance is determined by whether or not we are inhaling or exhaling, as well as if we are  breathing through the nose or the mouth, as each variable creates a different electrical response within the brain.   In the Northwestern study, participants were shown images of human expressions, some frightful, while engaging in various patterns of breathing. Researchers observed that people more easily process fear, and more readily recall images, while inhaling through the nose.   One of the major findings in this study is that there is a dramatic difference in brain activity in the amygdala and hippocampus during inhalation compared with exhalation. When you breathe in, we discovered you are stimulating neurons in the olfactory cortex, amygdala and hippocampus, all across the limbic system. ~Christina Zelano, assistant professor of neurology at Northwestern University Feinberg School of Medicine and lead author of the study   The amygdala is decisively liked to the processing of emotions, especially those related to fear, while the hippocampus is strongly linked to memory recall, and the breath, which originates with the diaphragm, plays the critical role of regulating their function.   Breathing is modulated at the diaphragm, and it is also the location where many physical symptoms associated with fear and anxiety manifest. ~Brett Wilbanks The differences in brain activity which occur during unique breathing rhythms were recognized by looking at brain activity during the introduction of fearful or surprising human faces, finding distinctively heightened activity during inhaling. Knowing this can be highly advantageous when you realize that your fear reaction is working overtime.     We can potentially use this fact to our advantage. For example if you’re in a dangerous environment with fearful stimuli, our date indicate that you can respond more quickly if you are inhaling through your nose. ~Christina Zelano   Furthermore, this further validates the importance of meditation, which commonly centers of developing control of the breath in order to quiet the mind and normalize physiological function in the body. The long-term results of a dedicated meditation practice include more stable and optimal emotional reactions to the world around us, indicating again that breathing is a critical component of living a fearless life.       Study: Diet high in poor quality carbohydrates increases heart disease and death McMaster University (Ontario), February 28, 2021 A global study of people living on five continents has found a diet high in poor quality carbohydrates leads to a higher risk of heart attacks, strokes, and death. The higher risks of a diet high in poor quality carbohydrates, called a high glycemic diet, were similar whether people had previous cardiovascular disease or not. The study, published in the New England Journal of Medicine today, is the largest of a geographically and dietary diverse population on this issue, as previous studies have chiefly focused on high income Western countries. A total of 137,851 people aged 35 to 70 years old were followed for a median of 9.5 years through the Population Urban and Rural Epidemiology (PURE) study run by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences. The research team used food questionnaires to measure long term dietary intake of participants and estimate the glycemic index (the ranking of food based on their effect on blood-sugar levels) and glycemic load (the amount of carbohydrates in a food times its glycemic index) of diets. There were 8,780 deaths and 8,252 major cardiovascular events recorded among the participants during the follow-up period. The investigators categorized dietary intake of carbohydrates depending on whether specific types of carbohydrates increased blood sugars more than others (high glycemic index) and compared this index to the occurrence of cardiovascular disease or death. Those people consuming a diet in the highest 20 percent of glycemic index were 50 percent more likely to have a cardiovascular attack, stroke, or death if they had a pre-existing heart condition, or 20 percent more likely to have an event if they did not have a pre-existing condition. These risks were also higher among those people who were obese. "I have been studying the impact of high glycemic diets for many decades, and this study ratifies that the consumption of high amounts of poor quality carbohydrates is an issue worldwide," said first author David Jenkins, professor of nutritional sciences and medicine at the University of Toronto's Temerty Faculty of Medicine, who is also a scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto. "PURE study papers have already indicated that not all carbohydrates foods are the same. Diets high in poor quality carbohydrates are associated with reduced longevity, while diets rich in high quality carbohydrates such as fruit, vegetables and legumes have beneficial effects," he said. PHRI research investigator Mahshid Dehghan added: "This study also makes it clear that among a diverse population, a diet low in both its glycemic index and load has a lower risk of cardiovascular disease and death." Most fruits, vegetables, beans, and intact whole grains have a low glycemic index, while white bread, rice, and potatoes have a high glycemic index. "The present data, along with prior publications from the PURE and several other studies, emphasize that consumption of poor quality of carbohydrates are likely to be more adverse than the consumption of most fats in the diet," said Salim Yusuf, senior author of the study. "This calls for a fundamental shift in our thinking of what types of diet are likely to be harmful and what types neutral or beneficial." Yusuf is also the principal investigator of the PURE study, executive director of the PHRI, and a professor of medicine at McMaster.

What foods and supplements help improve fertility for those trying to conceive naturally and for those undergoing fertility treatment. We talked with Dr. Jorge E. Chavarro, Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health and Medicine at Harvard Medical School. Dr. Chavarro’s research is focused on understanding how nutrition and lifestyle impact human reproduction. He is the Principal Investigator of the Nurses’ Health Study 3 – an ongoing prospective cohort of young professional women started in 2010 designed to investigate the role of lifestyle and biologic factors on women’s health – and leads the nutritional component of the EARTH Study, an ongoing prospective cohort of couples undergoing infertility treatment at the Massachusetts General Hospital.In this episode, we cover:How Does Nutrition Impact FertilityWe know that women are born with all the eggs they are ever going to have so how does nutrition impact female fertility and egg quality?How does nutrition impact male fertility?How does weight and BMI affect fertility?We know that the microbiome in our reproductive tract is important to fertility. Does what we eat impact this microbiome?What Foods and Diet are Best for Enhancing FertilityWhat foods improve natural fertility or the fertility of those in fertility treatment?What is the importance of protein? What type of protein is bestRole of carbohydrates in fertility. Low carb? Complex vs simple carbs?CaffeineSoy productsWhat Supplements are Effective at Improving FertilityWhat supplements should you take if you are trying to conceive with or without fertility treatment?Prenatal vitaminMicronutrient supplementationFolatesCoQ 10Vitamin B12DHEA (dehydroepiandrosterone)Vitamin DFish OilSupport the show (https://creatingafamily.org/donation/)

Learn about recent articles going over how plant based diets are beneficial for both diabetes and depression as well as other health outcomes. Click here to apply for a free initial consultation: https://form.jotform.com/193528759357172 Hit me up! Would love to connect! Website: https://vitaminkatie.com/ Facebook: https://www.facebook.com/ktreinesy Instagram: https://www.instagram.com/vitamin.katie/ Email: k.reines1@gmail.com References: ‘Our results suggest that, despite major advances in diabetes drug discovery and movement to develop innovative care delivery models over the past two decades, achievement of diabetes care targets has not improved in the United States since 2005” https://www.massgeneral.org/news/press-release/study-finds-achievement-of-diabetes-treatment-targets-has-not-improved-in-the-united-states-since-20051 IN 5 US ADOLESCENTS ARE PREDIABETIC - UNTIL RECENTLY CHILDREN AND ADOLESCENTS NEVER GOT TYPE 2 DIABETES https://www.cnn.com/2019/12/02/health/prediabetes-adolescents-study/index.htmlResearch shows that plant-focused eating offers clearly positive outcomes for people with diabetes – with reductions in blood sugar, lipids and body weight. There are many ways eating more plant-based foods benefits people with diabetes: https://health.usnews.com/health-news/blogs/eat-run/articles/can-eating-more-plant-based-foods-help-manage-diabetesA low-fat vegan diet induces changes in gut microbiota that are related to altered body composition and insulin sensitivity, and result in weight loss, according to results of a randomized controlled trial in overweight/obese adults.https://www.medscape.com/viewarticle/918508Our findings support recommendations to increase intakes of certain soy products for the prevention of type 2 diabetes https://academic.oup.com/ajcn/article-abstract/111/3/677/5698395?redirectedFrom= fulltext From these results, we can say that a pre-pregnancy plant-based diet, particularly one that also limits unhealthful plant-based foods such as refined grains, potatoes, and sugar-sweetened foods and beverages, may be associated with a lower risk of gestational diabetes," Frank Qian, MD, from the Harvard T. H https://www.medscape.com/viewarticle/932548Harvard’s long-running Nurses’ Health Study found that women who consumed more anthocyanins (the pigment that makes blueberries blue and strawberries red) were less likely to develop type 2 diabetes than women who consumed fewer of these health-promoting compounds. https://www.msn.com/en-us/health/nutrition/4-science-backed-reasons-people-with-diabetes-can-eat-fruit-worry-free/ar-AAH8oqEHigh blood sugar linked to depression even in non diabetics medha https://medicaldialogues.in/diabetes-endocrinology/news/high-blood-sugar-linked-to-depression-even-in-non-diabetics-finds-study-70643"Our study shows high GI foods, like potatoes, can be consumed as part of a healthy evening meal without negatively affecting GR -- and while delivering key nutrients in relatively few calories, which is essential for people with T2D."https://medicaldialogues.in/diet-nutrition/news/potato-based-diet-doesnt-disturb-blood-sugar-control-in-diabetes-study-70826Death Rate: https://www.businessinsider.com/covid-19-compared-to-other-common-us-causes-of-death-2020-5

Dermatology news: Data on potential risks of COVID-19 in psoriasis patients limited, but reassuring: https://bit.ly/3jwNc0Q Red hair in women linked to elevated CRP levels in Nurses’ Health Study: https://bit.ly/2HyJRSb Rinse and repeat? Mouthwash might mitigate COVID-19 spread: https://bit.ly/2HKjF6w *  *  *   Dermatologists must feel comfortable and confident in diagnosing skin conditions in patients with skin of color, which begins during residency. In this resident takeover, Daniel R. Mazori, MD, and Nadine Shabeeb, MD, MPH, discuss how images of skin of color are greatly underrepresented in dermatology education resources, specifically textbooks and online resources. “We really rely on our textbooks for images and photographs of disease entities that we may not see that often clinically, and so if all of our patients are not represented in our resources and if we’re not seeing those patients in clinic, we’re really not ever going to be able to accurately learn and diagnose certain skin diseases,” Dr. Shabeeb explains. She also talks about her efforts to improve and strengthen the skin of color curriculum and provide antiracism resources within her residency program. Article: https://bit.ly/3kvBTHo PDF: https://bit.ly/35CfF0a *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin–Madison) Disclosures: Dr. Mazori and Dr. Shabeeb report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Monologue Dr. Joel Wallach begins the show today discussing "broken heart syndrome". Asserting that this is hypertrophic heart attacks. Stating that he and his wife Dr. Ma Lan did thousands of autopsies of children in China who died from this disease. Contending that this is due to a deficiency of a single mineral. Recommending that if everyone supplemented with all 90 essential nutrient most diseases could be wiped out. Pearls of Wisdom Doug Winfrey and Dr. Wallach discuss a news article regarding a part of the Nurses Health Study. Looking at data of over 28,000 women and their physical activity. Those exercising 60 minutes daily had a lower risk of developing adenomas. These adenomas have long been linked to an increased risk of colorectal cancer. If women exercised both as adolescents and later as women they lowered their risk by 24%. Callers Lynn's sister has several health challenges including vertigo, Parkinson's symptoms, tremors and dementia. Bethel has questions about weight loss. Lee has a friend diagnosed with Parkinson's disease. Steve has questions about lypomas and getting off of antidepressants. Rosa believes that she has osteoporosis of the skull. Call Dr. Wallach's live radio program weekdays from noon until 1pm pacific time at 831-685-1080 or toll free at 888-379-2552.

Have you ever wondered what the direct impact of what you’re eating has on your chances of getting pregnant? Today’s episode is all about food and fertility, and our guest is an expert in the field. Dr. Jorge Chavarro is the Associate Professor of Medicine at Harvard Medical School and the Co-Director of Epidemiology and Genetics Core at Boston Nutrition Obesity Research Center. His research focuses on investigating the role of nutritional factors in the pathogenesis of diseases affecting reproductive and hormone sensitive organs. He is the co-author of the veritable Bible of fertility nutrition, titled The Fertility Diet, which reveals startling research from the landmark Nurses’ Health Study that shows how the food you eat can either boost or reduce your fertility. Today, we speak to Dr. Jorge, who is a role model on the important nutrients and specific foods for fertility, about the potential dangers of soda, plastics, and the environment and their impact on fertility, as well as current research on health and fertility. We discuss The Fertility Diet and how Dr. Jorge came to write it, and we go into detail about the effects of trans-fatty acids, high glycemic load, and animal protein, including fish and full-fat dairy.

We had so much to say about PCOS fertility we decided we had to do a part 2. This time it's all about the science and the supplements. - Brigitte talks about a PCOS symptom she’s been experiencing that no one really talks about - We break down our absolute favourite supplements/herbs for fertility - why they work and how they helped us. - Mel talks about how she naturally passed the retained tissue she experienced after her miscarriage. - We talk about what might be stopping you from ovulating – big tip: it isn’t the same for all women with PCOS! - Brigitte blows us away with incredible and informative stats. Mel: She’s so clever! - Why folic acid isn’t exactly what you should be taking when you’re trying to conceive - The essential fertility vitamin that 85% of women with PCOS are deficient in - For all our dairy lovers out there – listen in to hear how to consume dairy in a more fertility-friendly way - Mel talks about the Nurses Health Study: https://www.nurseshealthstudy.org/ - The Fertility Diet Book that Mel talks about: https://www.amazon.com.au/Fertility-Diet-Groundbreaking-Research-Ovulation-ebook/dp/B0010QI2J4 - The 3rd clinical sign that you should avoid A1 Dairy (that Mel so gracefully couldn’t remember) is recurrent bronchitis or tonsillitis as a child. - The food group needed to create healthy hormones. Make sure you follow us on Instagram @thepcosgirls and come join the conversation in our private podcast community at www.facebook.com/groups/thepcosgirls Mel and Brig xo

On this episode, Kris talks with one of the world's leading anti-aging doctors, Dr. Dave Woynarowski to talk about biological age. We dive into how to protect and even lengthen your telomeres to improve your healthspan. Time Stamps A family of healers. Dr. Dave’s background, history and personal connection to his work in anti-aging [0:40] Why testosterone supplementation, for hormonal reasons, can be useful in the health of the aging male [4:58] How to combat the effects of overtraining [8:25] What is a telomere? [14:42] All telomere tests are NOT created equal [19:12] What are the contributing factors that lead to shortened telomeres? [22:18] How diet, fasting can contribute to your body's longevity response [31:34] Bio hacks to reduce the length of your telomeres. [41:07] Why he is NOT a big fan of metformin [50:57] The buzz around peptides [54:18] Telokynase, the telomere activator [56:01] Featured Guest: Dr. Dave Woynarowski Website YouTube Facebook Twitter Related Links/Products Mentioned The Longevity Edge Ready, Set, Go! Synergy Fitness – Book by Phil Campbell Dr. Mercola Interview with Phil Campbell - YouTube Peak 8 Exercise Breakthrough - Dr. Mercola Dr. Rhonda Patrick: “Proof That Saunas Help Improve Heart Health and Healthspan” Life Length **Code GETHIN15 at checkout** Lifestyle Changes May Lengthen Telomeres, A Measure of Cell Aging Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer 1st Edition – Book by Thomas Seyfried Higher Omega-3 Level Associated with Reduced Telomere Shortening Rate Da Vinci Bio Sciences Publishes Paper On Stem Cell Therapies, The Reality of Their Use In Anti-Aging Procedures The Fountain of Youth with Peptides: Discover the Regenerative Powers of Peptides – Book by Edwin Lee Episode Sponsors Now more than ever it is massively important to make sure your immune system is in tip top shape. BiOptimizer's P3OM does just that with it's "Navy Seal" team of probiotics. If you want to stay healthy it starts with your gut and there isn't a better gut support than P3OM. Use the code KRIS20 at P3OM.com to get 20% off the best probiotic on the market. Speaking of optimizing your immune system... Laird's Superfood is here to do that and so much more with their Performance Mushroom Blend. Laird's uses some of the best varieties of mushrooms to support your immune system and cognitive health. Use the code GETHIN20 to get 20% off at LairdsSuperfood.com. Feeling stress or anxiety in your everyday life or because of the state of the world? One of the best ways to relieve the symptoms of anxiety and calm down is with CBD. Now not all CBD is created equal that's why Kris turns to Ned CBD. Ned uses full spectrum CBD from REAL hemp. No isolates, no synthetic ingredients, just CBD and organic MCT oil. Go to HelloNed.com/Gethin or simply use the code GETHIN to get 15% off and free shipping on your first order. Connect with Kris Instagram: @krisgethin

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr Greg Hundley: I'm Greg Hundley, associate editor from the VCU Pauley Heart Center in Richmond, Virginia. Dr Carolyn Lam: Greg today's speaker paper is all about soy products and whether or not there is a benefit with them with regards to risk of coronary heart disease. Now, this has been extremely controversial and today's speech or paper is really important in its findings. Ha ha, I bet you want to get to it right now but I'm going to say, hold on let's get to some other really interesting papers in this series first. Can I start off? You got your coffee? Dr Greg Hundley: Yes. Let's get going Carolyn. Dr Carolyn Lam: So the first paper I want to highlight really talks about myocardial energetics in obesity, and you're going to love this one Greg it's got some really cool MRI techniques. We know that obesity is strongly associated with exercise intolerance and the development of heart failure particularly HFpEF. Well Dr Rayner from University of Oxford and colleagues looked at this carefully in 80 volunteers, which included 35 controls with an average BMI of 24 and 45 obese individuals with an average BMI of 35, who did not have coexisting cardiovascular disease. Now, these participants underwent body composition analysis and MRI of the abdominal liver and myocardial fat content, left ventricular function and 31 Phosphorus Magnetic Resonance Spectroscopy to assess Phosphocreatine ATP and Creatine Kinase Kinetics at rest and during Dobutamine Stress. Dr Greg Hundley: Oh, wow Carolyn, this is right up my alley. You've got MRI imaging for body composition coupled with MR spectroscopy for metabolism, so what did they find? Dr Carolyn Lam: Thanks for putting that simply for us Greg. They found that in the obese resting heart, the myocardial creatine kinase reaction rate is increase, maintaining ATP delivery despite reduced energy stores during increased workload. While the non obese heart increases ATP delivery through creatine kinase the obese heart does not, and this is associated with reduced systolic augmentation and exercise tolerance. Weight Loss reversed these energetic changes, so these findings really highlight myocardial energy delivery via creatine kinase as a potential therapeutic strategy to improve symptoms in obesity related heart disease, as well as a fascinating modifiable pathway involved in the progression to heart failure. Now with this paper the central illustration is so critical, everybody has to pick up that issue and have a look. Furthermore, you must read the elegant editorial by Barry Borlaug and Craig Malloy. Dr Greg Hundley: Oh, you bet Carolyn. Craig always puts these MR spectroscopy papers in such fantastic perspective, really looking forward to that read and such an elegant study. Now, we haven't had Carolyn's quiz in weeks and we're going to get into one. This paper comes from Professor Nina Wettschureck, from the Max-Planck-Institute for Heart and Lung research, and it pertains to the infamous G-protein coupled receptors. Now, Carolyn here's your quiz and guess what, it's just multiple choice. All you have to do is fill in the blank. Dr Carolyn Lam: On G-protein coupled receptors? Dr Greg Hundley: Yeah, I know it's... we know a lot about these, but we're going to learn. So, G-protein coupled receptors are the largest family of transmembrane receptors in eukaryotes. They transduce signals of numerous physio-chemical stimuli including... and Carolyn you have to complete this sentence. So it's neurotransmitters, hormones, local mediators, metabolic or olfactory cues and got to complete the sentence. Is it air resistance? Time? Or light? Dr Carolyn Lam: Space. Dr Greg Hundley: That's not a choice. Dr Carolyn Lam: All right, all right let me guess light. Dr Greg Hundley: That's awesome. Fantastic, great job Carolyn. So in the vascular system the contract alternative vessels is crucially regulated by these GPCRs, including basic constrictors such as Angiotensin two and Endothelin one. In this study the investigators studied the role of GPRC5B, and the regulation of contractility and differentiation in human and murine smooth muscle cells in vitro, as well as in tamoxifen inducible smooth muscle cells Pacific knockout mice under conditions of arterial hypertension and atherosclerosis, and these experiments were done in vivo. Dr Carolyn Lam: Okay, so what were the results? Dr Greg Hundley: They found that GPRC5B regulates vascular smooth muscle tone and differentiation by negatively regulating prostate cycling receptor signaling. Thus, Carolyn inhibition of the interaction between GPRC5B and the prostacyclin receptor might be beneficial in human arterial hypertension and vascular remodeling. What a great new insight into basic science. Well, let me get on I have a clinical paper, and this is on the infamous topic from the COMPASS-PCI trial, Rivaroxaban plus Aspirin versus Aspirin alone in patients with Prior Percutaneous Coronary Intervention from Dr Kevin Bainey at the Canadian VIGOUR Center in University of Alberta. So Carolyn, the cardiovascular outcomes for people using anticoagulation strategies or COMPASS trial demonstrated dual pathway intervention with Rivaroxaban 2.5 milligrams twice daily plus aspirin, and 100 milligrams once daily versus aspirin 100 milligrams once daily, reduced the primary major adverse cardiovascular event outcome of cardiovascular death, MI or stroke as well as mortality in patients with chronic coronary syndromes or peripheral arterial disease. Now, whether this remains true in patients with a history of PCI is unknown. Dr Carolyn Lam: Oh, Greg I'm so disappointed. Why didn't you give me a quiz here? I know about the COMPASS trial. Okay, so what did the author's find? Dr Greg Hundley: So Carolyn of the 27,000 plus patients in COMPASS 16,500 plus patients had chronic coronary syndrome, were randomized to DPI or aspirin and of these 9,862 had prior PCI. So here are the results, DPI compared with aspirin produce consistent reductions in MACE mortality, but with increased major bleeding with or without prior PCI. So among those with prior PCI one year and beyond, the effects on MACE and mortality were consistent irrespective of time since the last PCI. Dr Carolyn Lam: Mm-hmm (affirmative) Interesting implications on dual platelet inhibition. Well, let me tell you a little bit about what's in the mailbag in the rest of this issue. There's a research letter by Dr Joseph Wu on molecular signatures of beneficial class effects of statins on human induced pluripotent stem cell derived cardiomyocytes. We have global rounds by Dr Annika Rosengren and Dr Lars Wallentin on the cardiovascular medicine in Sweden. We have a White Paper by Dr Abhinav Saxena and colleagues on the value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. And we also have paired perspective pieces, one by Dr Salim Virani and colleagues on secondary prevention of atherosclerotic cardiovascular disease comparing recent United States and European guidelines on dyslipidemia, and another by Dr Neil Stone and colleagues on comparing primary prevention recommendations with the focus look at the US versus European guidelines on dyslipidemia. Dr Greg Hundley: Very good, Carolyn. Well, I've got a research letter Professor Do-Young Kwon from the Korea University of Ansan Hospital, Korea University College of Medicine and discusses the association of Parkinson's disease with the risk of cardiovascular disease and all-cause mortality, and a nationwide population-based cohort study. In addition, different series of letters Dr Seung-Jung Park from Asan Medical Center at the University of Ulsan College of Medicine, and Professor Lang Li of The First Affiliated Hospital of Guangxi Medical University exchanged letters regarding the article, Clinically Significant Bleeding With Ticagrelor versus Clopidogrel in Korean patients with Acute Coronary Syndromes Intended for Invasive Management, that previously published randomized clinical trial. Then finally one of those great ECG investigations from Dr Miguel Arias, and they have an ECG quiz entitled The Hidden Reveals the Hidden, but really, it's referring to a Brugada ECG pattern and a patient with Wolff-Parkinson-White. I can't wait to get onto that feature article discussing the potential benefits or harms of soy in men and women as it relates to cardiovascular disease. Dr Carolyn Lam: Yeah, you and I Greg let's go. Oh, boy today's feature paper really literally cuts close to the heart for me talking about soy products, and whether or not there's a relationship with cardiovascular health. This remains controversial but thankfully we've got really great data just published in this week's issue, so proud to have the first author with us Dr Qi Sun from Brigham and Women's Hospital, as well as our associate editor who's also an editorialist for this paper and that's Dr Mercedes Carnethon from Northwestern University Feinberg School of Medicine. So welcome both I cannot wait to just jump right into it. Please, Qi, tell us what you found about soy products. Dr Qi Sun: First off this is a prospective cohort study that included three cohort studies, the Nurses’ Health Study and the Nurses’ Health Study II and Health Professionals Follow-Up Study. So those three big prospective cohort follow up studies. Now over the years we have collected much data of diet which has been repeated, reviewed, and assessed over the years, and we have accumulated many cases of cardinal heart disease the numbers are a solid. Now what we found is that the intake isoflavones which are the big family are flavonoids, the higher intake of isoflavones were associated with a lower risk of developing coronary heart disease in those three cohorts of men and women. And in addition because tofu and soy milk are the primary contributor in our guide of isoflavones, we also examine the tofu and soy milk in relation to the risk of cardinal heart disease What we found is that tofu intake is significantly associated with lower risk of developing heart disease, and soy milk is also associated with lower risk of developing heart disease. It's just the association for soy milk, soy milk is not significant. And I think very interestingly we also found that the menopausal status and the postmenopausal hormone use somewhat also modulated association primarily for coffee intake with heart disease risk, in that we found younger women who were before their menopause and also postmenopausal women who did not use hormone will benefit more from tofu intake. In contrast, for postmenopausal women who are using hormone the association was not significant. I think those are the primary findings of our prospective cohort study. Dr Carolyn Lam: Oh my goodness, hallelujah. That's really marvelous and beautifully summarized, Mercedes please explain why was this such a controversial area before? And what does this paper add? Love your editorial by the way. Mercedes Carnethon: We hear a lot about nutritional epidemiology studies, and we have a lot of debates about what we should believe, whether we should change our behavior based on these observational studies and quite often we have discussions about what's new. And I lean on that final point about why I like this particular paper so much, and that's because I found the topic of isoflavones, tofu intake and soy to be extremely relevant to a large proportion of the world's population, whose primary protein intake may be something made from a soybean, heavy and isoflavones. Within the United States it's also relevant even though a smaller proportion of our population relies primarily on vegetarian diet, there is a very large and interested group wondering whether soy intake is safe. There have been discussions about whether there's harm associated with it, and the possibility that it could have beneficial influence on our leading causes of death of coronary heart disease. So I was most thrilled about the innovation of this particular topic, and its methodological rigor. When we think about what we lean on, we lean on large studies, we lean on multiple events and the size of the study allowed the investigators to explore numerous subtleties. Subtleties such as that reported related to the moderation by menopausal status, and that was the point I was most curious about and why I'm really excited to have an opportunity to talk to you today Chi. Can you tell me a little more about the menopausal status finding? Dr Qi Sun: So first off as I mentioned tofu intake was more strongly associated with lower risk of developing heart disease among younger pre-menopausal women, or postmenopausal women who did not use ham. Before that I want to also mention for isoflavones intake where I also found a similar pattern in that isoflavones are more. Appear to be more strongly associated with lower risk also in those two groups of women, although the past by interaction was non-significant. Now in terms of why I think there are a couple reasons why is that, among postmenopausal female or in our use hormone, the isoflavone can function as estrogen and provide at least partially the estrogenic effects that were calculated in postmenopausal women who do not use hormone, and for premenopausal women we think that's probably because before menopausal, the activity of estrogen receptor may be higher than the estrogen receptor after menopausal. So, in reality, the other variables of isoflavones may provide estrogen effects after menopausal. So those are the hypotheses although I have to mention that those hypotheses, we need more evidence to really shed light on the mechanisms underlying those interactions between menopausal status, postmenopausal hormonal use, where's the intake of isoflavones and tofu. Dr Carolyn Lam: So Chi I love that explanation and giving it some biological possibility, although as you said it's a postulation. But may I ask so what's the implication for men? I lived with a man who thinks if he takes soy he's going to grow boobs. So what... did you see any sex differences and do studies like this and able looking for the downsides of eating soy? Dr Qi Sun: As a scientist I'm open to any kind of new findings as long as the findings are from well conducted, rigorously designed study. But having said that I couldn't exclude the possibility that maybe soy intake is associated with certain adverse health outcomes, but so far based on my experience I didn't see any such evidence. But having said this I always say I wouldn't risk any possibility, but coming... circling back to the coronary heart disease we really didn't see much difference between men and women. It's true for the younger women we saw a stronger association but for men I also see a lower risk of heart disease. So there's a kind of interesting image on soy intake or isoflavones intake in the United States that people believe they are estrogen so a man shouldn't take it, but if you look at the group of vegetarians, the vegans. There are a lot of guys they practice vegetarian, they practice vegan diets and we also publish on plant-based diet in relation to coronary heart disease and lot of men eat very healthy. And we found those people who practice those kinds of healthy diets, soy is often mouthful of primary sources of proteins and if you look at their risk of developing heart disease, type two diabetes is quite low. Something lower than other normal women who practice otherwise omnivore diet. Dr Carolyn Lam: It's true Qi soy intake could also be a marker of a healthier lifestyle in general, by extension of what you just said. But Mercedes I love that you discuss quite a number of these issues in your editorial and at the end of the day you asked the most important question, what does this mean for us? Should we all be increasing our intake of soy products? Could you give us your synthesis of that? Mercedes Carnethon: Yes, a point that I've definitely tried to make here, and this is really in response to what I expect to be the media fear surrounding new dietary findings. One of the first questions that I know that she and his colleagues will be asked is, should I change my diet? Can I extend my life? And that's because the media is really looking for a lot of sensational headlines in this topic, and I think we have to focus on what we learn from these observational studies. They're a very important step in the scientific process that helps us provide a justification for later clinical trials, that helps us think about the multiple components that work together to promote overall excellent health. And the point you were making right before this about the individuals who eat plant based diets that are heavily based in soy. In the paper it also describes that those individuals exercise more, they may have lower intakes of saturated fat, and so I think ultimately what I take from this at least for myself and for people who would ask is that an overall healthy diet seems to stand up very well in these well done observational studies. And that soy in particular may be a part of an overall healthy diet given what we're seeing here in this very well done study. Dr Carolyn Lam: Oh, that's beautifully put Mercedes and Chi perhaps I can give you the last word. What would you say is the take home message and what are next steps? Dr Qi Sun: I think the core message is this as Mercedes very well discussed, I think soy and especially tofu can be really good components of the overall healthy plant based diet, and by practicing that I think we can significantly reduce the risk of developing coronary heart disease for both men and the women. I think moving forward we would like to see evidence from clinical trials that target cardiometabolic risk factors as outcome, and to see whether increased consumption of tofu and isoflavones can really reduce those risk markers so that they have ample evidence to support the mechanisms. As you mentioned Carolyn that this is an initial study, and it could be soy, intake could be just macro how is it, through clinical trials, we can really control those confounding factors and really provide good evidence to support our findings. Dr Carolyn Lam: Well, in the meantime I just have to say you made my day this is coming from a soy eating vegetarian, so thank you so, so much. Thank you, listeners for joining us today. Dr Greg Hundley: This program is copyright the American Heart Association 2020.  

This Week In Wellness a healthy lifestyle leads to a life that is free of chronic illness including diabetes, cardiovascular disease and cancer for longer. Using data from the Nurses Health Study and the Health Professionals follow up study this paper in the British Journal of Medicine was able to confirm that never smoking, maintaining Listen In The post TWIW 50: Healthy lifestyle adds 10 disease free years appeared first on The Wellness Couch.

What foods and supplements help improve fertility for those trying to conceive naturally and for those undergoing fertility treatment. We talked with Dr. Jorge E. Chavarro, Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health and Medicine at Harvard Medical School. Dr. Chavarro’s research is focused on understanding how nutrition and lifestyle impact human reproduction. He is the Principal Investigator of the Nurses’ Health Study 3 – an ongoing prospective cohort of young professional women started in 2010 designed to investigate the role of lifestyle and biologic factors on women’s health – and leads the nutritional component of the EARTH Study, an ongoing prospective cohort of couples undergoing infertility treatment at the Massachusetts General Hospital.Support the show (https://creatingafamily.org/donation/)

On episode 243 of The Nurse Keith Show nursing career podcast, Nurse Keith discusses The Nurses' Health Study 3 (NHS 3) with Dr. Jorge Chavarro, Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health and of Medicine at Harvard Medical School. The NHS is an ongoing prospective cohort of young professional women begun in 2010 designed to investigate the role of lifestyle and biologic factors on women’s health.  Nurse Keith is a holistic career coach for nurses, as well as a professional podcaster, published author, inspiring speaker, and successful nurse entrepreneur. Show notes NurseKeith.com Facebook.com/NurseKeithCoaching Twitter.com/nursekeith Instagram.com/nursekeithcoaching LinkedIn.com/in/keithallancarlson

  Episode 278 is an all inclusive guide to kidney anatomy, health, bloodwork, and MORE for physique and performance based athletes! First I dig into some basics on kidney anatomy and function before moving into some considerations for athletes looking to get bloodwork done to track kidney health, and all before ending with practical application on how to maintain kidney health while pushing for your goals! Also, theres a few references I'll provide below for those looking to take things further!   REFERENCES Adelstein RS, Sellers JR. Effects of calcium on vascular smooth muscle contraction. The American journal of cardiology. Jan 30 1987;59(3):4b-10b.   Agre P, King LS, Yasui M, Guggino WB, Ottersen OP, Fujiyoshi Y, . . . Nielsen S. Aquaporin water channels--from atomic structure to clinical medicine. The Journal of physiology. Jul 1 2002;542(Pt 1):3-16.   AHA. American Heart Association. Kidney Damage and High Blood Pressure. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Kidney-Damage-and-High-Blood-Pressure_UCM_301825_Article.jsp. Last updated 9/11/2014a. Accessed 8/10/2014.     Akinwusi PO, Oluyombo R, Ogunro PS, Adeniji AO, Okunola OO, Ayodele OE. Low dose aspirin therapy and renal function in elderly patients. International journal of general medicine. 2013;6:19-24.   Al-Awqati Q, Barasch J, Goldman L (ed.), SchaferAI (ed.). Goldman's Cecil Medicine, Twenty-Fourth Edition. Chapter 117: Structure and Function of the Kidneys; 716-720. Copyright 2012 Saunders, an imprint of Elsevier, Inc. Available at: www.clinicalkey.com Accessed: 6/9/2014.   Alpern RJ, Sakhaee K. The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. American journal of kidney diseases : the official journal of the National Kidney Foundation. Feb 1997;29(2):291-302.   Amodu A, Abramowitz MK. Dietary acid, age, and serum bicarbonate levels among adults in the United States. Clinical journal of the American Society of Nephrology : CJASN. Dec 2013;8(12):2034-2042.   Anders HJ, Andersen K, Stecher B. The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney international. Jun 2013;83(6):1010-1016.   Babaei-Jadidi R, Karachalias N, Ahmed N, Battah S, and Thornalley PJ. Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine. Diabetes. 2003;52(8):2110–20   Bae EH, Lee J, Ma SK, et al. alpha-Lipoic acid prevents cisplatin-induced acute kidney injury in rats. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2009;24(9):2692–700   Balakumar P, Bishnoi HK, Mahadevan N. Telmisartan in the management of diabetic nephropathy: a contemporary view. Current diabetes reviews. 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  Dr. Carolyn Lam: Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the Journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: I'm Greg Hundley, associate editor from the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, you know I'm vegetarian and any paper on plant-based diet will always interest me, and of course, we have one as a featured paper this week, very interestingly talking about changes in plant-based diet quality, meaning that there could be good plant-based diets and not so good plant-based diets. I mean we all know that potato chips, for example, are still plant-based. But, anyways, so this feature paper discusses the changes in these plant-based diet quality and association with total and cost-specific mortality. Neat, huh? Dr. Greg Hundley: Yeah. I can't wait to hear about that one. I know that's a favorite topic of yours. How about if we have a sip of coffee and jump into our other articles? Dr. Carolyn Lam: Sure. I'm sipping away, and have already picked my first paper. This talks about mutations in plakophilin 2, which are the most common cause of gene-positive familial arrhythmogenic right ventricular cardiomyopathy. Dr. Greg Hundley: No quizzes for me on plakophilin 2, please. Dr. Carolyn Lam: All right, well, let me tell you all about it. Plakophilin 2 is classically defined as a protein of the desmosome, which is an intracellular adhesion structure. Studies though have suggested that plakophilin 2 also translates information at the initiation. Recent studies have also shown that plakophilin 2 translates information initiated at the site of cell to cell contact into intracellular signals that maintain structural and electrical homeostasis. Now, the important thing is that mutations in plakophilin 2 associated with most cases of gene-positive arrhythmogenic right ventricular cardiomyopathy or ARVC. However, the molecular and cellular mechanisms responsible for arrhythmias in ARVC remain unclear. Dr. Carolyn Lam: In today's paper, Doctors Delmar and Cerrone from New York University School of Medicine and their colleagues studied the role of cardiomyocyte plakophilin-2 expression in cardiac function. To do that, they utilized a cardiomyocyte-specific, tamoxifen-activated, plakophilin-2 knockout murine line. They found that loss of plakophilin-2 expression caused, as an early event and predominantly in the right ventricle, a non-transcriptional and likely arrhythmogenic, connexin-43-dependent disruption of calcium homeostasis. Dr. Carolyn Lam: The phenotype included accumulation of calcium in three intracellular compartments, the junctional sarcoplasmic reticulum, the cytoplasm, and the mitochondria. Right ventricular myocytes also showed increased eagerness of ryanodine-receptor-2 channels to release calcium from the sarcoplasmic reticulum. Intrinsic ryanodine-receptor-2 properties were also modified further contributing to the pro-arrhythmogenic state. In summary, the authors postulated that disruption of calcium homeostasis in the right ventricle is a major arrhythmia trigger in patients with ARVC. The data identified both the ryanodine-receptor-2 channel and the connexin-43 hemichannel as targets for antiarrhythmic therapy in this population. Dr. Greg Hundley: Very interesting that ARVC is such a worrisome concern, and gathering this mechanistic information is just so helpful. Dr. Carolyn Lam: Exactly. Dr. Greg Hundley: I have a basic science paper, but it was actually interesting because of the conduct was in many, many human subjects. It emanates from the large Million Veteran Program. There are a whole list of coauthors that are recognized as equal contributors, but Scott Damrauer actually serves as the corresponding author from the VA Medical Center. What it's addressing, about 13% of African American individuals carry two copies of the APOL1 risk alleles, G1 or G2, that are associated with a one and a half to two and a half fold increase in the risk of chronic kidney disease. Dr. Greg Hundley: There've been conflicting reports as to whether an association exists between these APOL1 risk alleles and cardiovascular disease independent of the effects of the APOL1 on kidney disease. Here, the investigators thought to test the association of these G1 and G2 alleles with coronary artery disease, peripheral arterial disease, and stroke among African American individuals in the Million Veterans Program. Dr. Carolyn Lam: Seems like a great study population and designed to look at this. What did they find? Dr. Greg Hundley: Among 30,903 African American Million Veterans Program participants, 3,941 or about 13% carried the two APOL1 risk allele, high-risk genotype. Individuals with normal kidney function at baseline with the two risk alleles had a slightly higher risk of developing coronary artery disease compared to those with no risk alleles. Similarly, modest associations were identified with incident stroke and peripheral arterial disease. However, when modeling both cardiovascular and renal outcomes, APOL1 was strongly associated with incident renal disease while no significant association with the cardiovascular disease endpoints could be detected. In conclusion, what the authors are indicating is that the APOL1 risk variants display a modest association with cardiovascular disease, and this association is likely mediated by the already previously known association of APOL1 with chronic kidney disease. Dr. Carolyn Lam: Interesting. Dr. Carolyn Lam: My next paper also has to do with chronic kidney disease and this time looking at metformin use and clinical outcomes in patients with diabetes with or without heart failure or kidney dysfunction. We know that metformin is the first-line therapy for type 2 diabetes, although its effects on the cardiovascular system are actually, not fully proven. In this next paper, the authors examine metformin use in the SAVOR-TIMI 53 Trial. Dr. Greg Hundley: Tell us a little bit about that SAVOR-TIMI 53 Trial. How is that organized? Dr. Carolyn Lam: Just as a reminder, the SAVOR-TIMI 53 trial was a multinational, randomized, controlled cardiovascular outcomes trial that compared the dipeptidyl peptidase-4 or DPP4 inhibitor, Saxagliptin, with placebo, enrolling almost 16,500 patients with type 2 diabetes and cardiovascular disease or elevated cardiovascular risk. Dr. Carolyn Lam: Now, in the current paper led by Dr. Bergmark from TIMI study group in Brigham and Women's Hospital and Harvard Medical School, the authors performed the post hoc analysis and looked at patients in SAVOR-TIMI 53 with baseline biomarker samples of whom there were more than 12,000 patients and classified these patients as ever versus never taking metformin during the trial period. The associations between metformin exposure and outcomes were estimated using inverse probability of treatment weighting, Cox modeling. Dr. Carolyn Lam: They found that among patients with type 2 diabetes and high cardiovascular risk in the SAVOR-TIMI 53 trial, metformin use was associated with lower rates of all-cause mortality including after adjustment for clinical variables and biomarkers, however not lower rates of the composite endpoint of cardiovascular death, MI or stroke. This association was most apparent in patients without prior heart failure or moderate to severe chronic kidney disease. Dr. Greg Hundley: Excellent. Dr. Greg Hundley: I'm going to transition to another clinical trial and this one is looking at ezetimibe in elderly patients and looking at efficacy for preventing cardiovascular-related events. The paper comes from Yasuyoshi Ouchi from Toranomon Hospital in Japan. Evidence regarding the primary prevention of coronary artery disease events by LDL-C/lipid-lowering therapy in order individuals that are above the age of 75 years, is somewhat incomplete. This trial tested whether LDL-C lowering with ezetimibe is useful for the primary prevention of cardiovascular events in older patients. They implemented a multicenter, prospective, randomized but open-label, blinded, endpoint, however, evaluation design conducted among 363 medical institutions in Japan. Dr. Greg Hundley: In the study, there're 3,796 patients that are aged greater than 75 years with elevated LDLC without a history of coronary artery disease that already were receiving dietary counseling. They're randomly assigned one-to-one to receive as ezetimibe 10 milligrams once daily versus usual care with their randomization stratified in a block design on age, sex, and baseline LDL-C. The primary outcome is the composite of sudden cardiac death, myocardial infarction, coronary revascularization, and stroke. Dr. Carolyn Lam: Ooh, so tell us the results. Dr. Greg Hundley: There were several patients that had to be excluded, so what ended up happening, there's 1,716 and then 1,695 that are included in each of the two respective arms for the primary analysis. What they found is that as ezetimibe reduced the incidents of the primary outcome. Then, regarding some secondary outcomes, the incidents of composite cardiovascular events and coronary revascularization were lower in the ezetimibe group than in the control group. But, there was no difference in the incidents of stroke, all-cause mortality, or adverse events in the two different groups. Dr. Carolyn Lam: Can you sum it up for us, Greg? What should we take home regarding ezetimibe and what further do we need to do? Dr. Greg Hundley: Good point, Carolyn. I think what we can take away from this study is that LDL-C lowering therapy with ezetimibe prevented cardiovascular events, suggesting the importance of LDL-C lowering for primary prevention in individuals greater than 75 years of age with an elevated LDL-C. However, remember, it was open label, so I think a placebo, controlled, randomized clinical trial will be required to validate the data that were obtained in this study. I think another study is probably going to be needed. Dr. Carolyn Lam: Thanks, Greg. Well, let's move on to our feature discussion, shall we? Dr. Carolyn Lam: Today's feature paper is of personal interest to me and I'm sure of widespread interest to everybody. Why? It's on plant-based diet. We've heard a lot about it. I'm vegetarian and very, very loudly self-confessed, but does the quality of a plant-based diet actually matter? Such an important question. Dr. Carolyn Lam: I'm so pleased to have the authors of this very remarkable paper, Dr. Megu Baden as well as Dr. Shilpa Bhupathiraju, both from the Harvard T.H. Chan School of Public Health; and our associate editor, Dr. Mercedes Carnethon from Northwestern University Feinberg School of Medicine. Welcome, ladies. What a nice chat we're going to have on this very personal topic to me as well. Dr. Carolyn Lam: First of all, maybe, could I ask, Shilpa, do we need another study on plant-based diet? Could you tell us the rationale for what you did this time? Dr. Shilpa Bhupathiraju: Like you said, when we talk about plant-based diets and what people usually think is, well, it's vegetarian or not. But, I think there's much more to a vegetarian diet. It's the quality that matters. Previous studies really then differentiate the quality of a vegetarian diet. To this extent, we developed plant-based diet indices, which actually capture the quality of a plant-based diet, so we have an overall plant-based diet index which captures the amount of plant-based foods; a healthy plant-based diet index, which captures the quantity of healthy plant-based foods; and again, the unhealthy plant-based diet index, which captures the quantity of unhealthy, plant-based foods. Dr. Carolyn Lam: Thanks. Meg, if you don't mind, I know everybody is asking this as they're listening. Could you give us some examples of what an unhealthy plant-based diet index would consist of compared to healthy? Then, perhaps, tell us a little bit about your study and what you found. Dr. Megu Baden: First of all, let me explain again. In this study, we use three versions of plant-based diet indices that can assess the quality of plant foods in general population. The first index is an overall plant-based diet index, PDI for short. A second one is a healthful plant-based diet index, HPDI. The third one is an unhealthful plant-based diet index, UPDI. In order to create these indices, we divide all food groups into three larger categories. One is the healthy plant foods, which contains whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea, and coffee; less healthy plant foods such as fruits juice, refined grains, potatoes, sugar-sweetened beverages, and sweets or desserts; and animal foods, which is animal food, dairy, eggs, fish, meat, miscellaneous animals-based food. Dr. Megu Baden: We investigated the association between preceding trailblazing changes in these indices and subsequent total and cause basic mortality in two large US cohorts. We found that compared with participants whose diet remained stable, the hazard ratio for total mortality, among those risks, the greatest increase in PDI was 0.95; for the greatest increase in HPDI, the healthful versions of the PDI was 0.90; and the greatest increasing in unhealthful PDI was 1.12. In contrast, the hazard ratio among participants with the greatest difficulty is in PDI, was 1.09; the greatest decrease in healthful PDI was 1.10; and the greatest decreasing in unhealthful PDI was 0.93. For CVD mortality, the risk was 7% lower for our 10 point increase in PDI, and 9% lower for HPDI and 8% higher for UPDI. Dr. Megu Baden: In summary, we found that improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of unhealthful plant-based diet was associated with a higher risk of total and CVD mortality. Dr. Carolyn Lam: Could I ask, Shilpa, to maybe add a line of ... have you applied this information in any way yourself or with patients, or is there an overwhelming take-home message you'd like people to remember? Dr. Shilpa Bhupathiraju: Yeah, I'm not a clinician myself, but I'm a public health researcher. I'm in India currently and I'm giving a talk to South Asians and the emphasis on vegetarianism. But, again, the quality of the vegetarianism is important. Being a vegetarian is not enough, but what goes into it is really important. If it's a white rice and sugar-sweetened beverages, it's not good, so really the emphasis should be on whole grains, consuming more nuts and legumes. I think that's important. Dr. Carolyn Lam: Oh, that's great. Mercedes, we've discussed this paper as associate editors, so proud to be publishing this in circulation. Could you share some of your thoughts on the implications of these findings? Dr. Mercedes Carnethon: The authorship team has done an outstanding job of clarifying a very complicated issue. I think what we really like about this and the ways in which it really adds to the literature, what you point out, that every vegetarian diet isn't the same. I was very impressed with the thought that went into classifying vegetarian foods as healthy or unhealthy. I would be interested in hearing more from the authors, particularly, since I feel they did a good job of how they dealt with complicated foods or mixed foods. I think one example given was a pizza, which has tomato sauce, but it also has other things, so I would love to hear from the authors how they classified complicated foods. Dr. Shilpa Bhupathiraju: The decision to classify pizza as an animal food was somewhat, I would say, arbitrary. I do agree that there's lots of tomato sauce, but again, I think the decision that went to it, it does have a ton of cheese, processed cheese, I think that's why we classified that as an animal food. The other complicated foods are mixed dishes that we struggled with were cream soups. We thought about what the base was or what the general preparation of that would be. Given that heavy cream is a major ingredient, so those were again, classified as animal foods. Dr. Mercedes Carnethon: I think there's a lot of logic in that and I really like the thought and care that you put into that. The other questions I have, I feel that you did a really nice job of, are even portion sizes. Tell me how you handled portions. Dr. Megu Baden: We basically take the information from our food frequency questionnaire. All of them are per the serving sizes, so we considered how participants reported how often on average they had consumed each food of our standard portion size in the past year. I know it's difficult to indicate the portion size. Shilpa, would you add something for the portion size for that? Dr. Shilpa Bhupathiraju: Yes. Like Megu said, we use standardized portioning sizes, so a cup of fruit, a cup of vegetables, an eight-ounce, or a cup of tea or coffee, so that's how we use what people use in general. The portion sizes are all specified on the food frequency questionnaire, so the nurses or the health professionals, they understand exactly what they're reporting. Is it a glass of fruit juice or half a glass? Then, we can word those frequencies into standardized serving sizes onto servings per day. Dr. Carolyn Lam: Great. Shilpa, could I follow up from Mercedes very important question? How does the index account for portion size too, as an is too much of even a good thing become a bad thing? You know what I mean? Dr. Shilpa Bhupathiraju: The index itself is a score. The way we capture it, as you know, everything is converted from frequencies into servings per day for each participant. Then, what we did was we divided the participants based on the distribution of the data into quintiles. Those in the highest category of the healthy plant foods received the highest points. The scoring varied a little bit based on which index we were calculating. But, in general, what we did was we divided everybody into five groups or quintiles. Then, the scoring varied depending on what we were calculating. For the HPDI, which is the healthy plant-based diet index, those in the fifth group or the highest intake received the maximum number of points, which was five. For the unhealthy plant-based diet index, those people received the reverse scoring, so they received zero points. Essentially, the participants were divided into quintiles and the scoring was done accordingly. Dr. Carolyn Lam: Maybe I could ask you a question on a different track, and I'm not sure if you have some answers here, but I noticed that your study population was impressive, almost 49,500 women from the Nurses' Health Study, almost 26,000 men from the Health Professionals Follow-up Study. Did you find any sex differences? Dr. Shilpa Bhupathiraju: We didn't find any sex differences. We did some sensitivity analysis by cohort and we didn't find a statistically significant interaction, which is I think good to note because we would expect the effects to be similar in men and women. Dr. Carolyn Lam: I think both men and women need to hear that. None of us are excused from, I suppose, trying to gear towards a healthy plant-based diet. I think that's what I'm hearing. Mercedes, do you have more thoughts to add? Dr. Mercedes Carnethon: I do. One thing I really like about this particular paper is the way the you acknowledge some of the limitations that we face when interpreting findings from observational studies, particularly observational studies of a health behavior when we know that health behaviors often cluster or correlate with other health behaviors. Can you tell us a little bit about some of the cautions and interpretation that you certainly acknowledged and presented very well? Dr. Shilpa Bhupathiraju: Sure. Our primary analysis was looking at changes, so long-term changes. When people change a diet or their lifestyle, they change something else. As you can see from our paper, those who improve the plant-based diet quality, we're also, in general, tended to be healthier. This being an observational study, we tried to control for those as to the greatest extent possible, but again, they could be residual confounding. We maybe failed to measure for certain things that we were unaware of or that we did not measure. I think we really can't get at causality, but I think the consistency of the evidence from our previous papers and from this paper point to a suggestion that improving plant-based diet quality is definitely associated with better health outcomes and a lower risk of death. But, again, it is important to know that this is observational and there could be changes in other health behaviors that we did not measure that could explain this association. But, we did as well of a job as we could in trying to control for these changes and other behaviors, lifestyles or even health conditions. Dr. Mercedes Carnethon: Thank you. Dr. Carolyn Lam: Thank you so much, Meg and Shilpa. You've been listening to Circulation on the Run. Don't forget to tune in again next week. Dr. Carolyn Lam: This program is copyright American Heart Association 2019

In this episode, we debunk a few myths on aging.  This episode is sponsored by McNeese Construction & WYSk Spark Radio, https://live365.com/station/Spark-Radio-a82219 If you would like to read our blog on this topic or any of the  others we have researched, you can do so by checking out our blog at www.yopistudio.com Check out our blog, podcast, and radio station at: www.yopistudio.com Feel free to see what we are up to by following us at:  https://twitter.com/Dauricee https://www.facebook.com/yopistudio/ https://www.facebook.com/LouisianaEntertainmentAssociation/ For comments or questions, you can reach us at yopi@post.com To read more about our topics check out the references below. References: 14(5):830-834, SEP 2007 Melov S, Tarnopolsky MA, Beckman K, Felkey K, Hubbard A (2007) Resistance Exercise Reverses Aging in Human Skeletal Muscle. PLoS ONE 2(5): e465. “Nurses’ Health Studies“. The Nurses’ Health Study. 2016-08-16. Retrieved 2017-07-17. J Biomech Eng.2015 Jan;137(1). doi: 10.1115/1.4028847. https://cals.arizona.edu/cpan/files/Metcalfe%20ACSM%20final%20article.pdf

Biosimilar pharmalogics are made from living organisms and offer a new and exciting way to treat breast cancer which can be less expensive, have fewer side effects and replicate the results of their chemical based counterparts.Dr. Chen earned her medical degree from the Perelman School of Medicine of the University of Pennsylvania and her Master’s of Public Health from the Harvard T.H. Chan School of Public Health.  She is a breast cancer medical oncologist and cancer epidemiologist. She works with the Nurses’ Health Study and has published extensively on nutritional, lifestyle, and hormonal factors that influence breast cancer risk and survival.  She also has a particular interest in translating epidemiologic findings to breast cancer clinical practice.  She is currently the study chair for the Aspirin for Breast Cancer (ABC) Trial, a large randomized trial of aspirin vs placebo to prevent breast cancer recurrence run through the Alliance of Clinical Trials in Oncology in the United States. Thank you to our partners who made this podcast possible - Merk and Amgen Oncology.

This is the audio commentary of the NephJC Chats on March 19 and 20, 2019.This week we discussed the study published in JAMA Network Open, on the kidney outcomes in NSAID users from the US military.The article (open access) is available here.The NephJC summary can be read here, with links to the visual abstract.Links from the show:In the background section, we mentioned the data from the Physicians Health Study (two reports) and the Nurses Health Study. There was also discussion about this high quality study from Switzerland in patients with rheumatoid arthritis.The NephMadness pain region scouting report, from Sam GelfandThe PRECISION trial published in NEJM, and the NephJC summary by Scherly LeonHigh risk of GI bleeding in CKD patientsA study from Taiwan reporting high risk of stroke with NSAIDs even in anuric patientsHost: Joel TopfCo-hosts: Samira Farouk, Swapnil Hiremath, Jennie Lin and Matt Sparks

Genitourinary syndrome of menopause causes a significant disruption in quality of life for many menopausal women. The ACOG and NAMS endorse vaginal estrogen to relieve local symptoms. However, the FDA has a current Black Box warning on vaginal estrogen. This podcast will cover brand new data from the Nurses Health Study, released December 20, 2018 in the journal, Menopause.

This Month in AJN – January 2019 monthly highlightsJanuary 2019Editor-in-chief Shawn Kennedy and clinical editor Betsy Todd present the highlights of the January issue of AJN. The authors of our first CE, “Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns,” examine this practice among nurses in the Nurses’ Health Study 3. Our second CE, “Addressing Food Insecurity in Vulnerable Populations,” discusses the factors that contribute to food insecurity and the populations at greatest risk, as well as screening tools and resources for vulnerable patients. In our next article, “Helping Students to Be Gritty,” the author shares strategies for fostering grit—a trait marked by perseverance and resilience and associated with success—in nursing students. “Early, Nurse-Directed Sepsis Care” describes a single-center, multiyear quality improvement initiative designed to promote early recognition and treatment of sepsis and examines its effect on sepsis-related mortality rates, bundle adherence, and the need for rapid response team calls. In addition, there’s News, the Book of the Year Awards, Reflections, Drug Watch, Art of Nursing, and more.

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Did you know that despite being one of the wealthiest nations in the world, the United States population has a shorter life expectancy compared to almost all other high-income countries in the world? Well, stay tuned to learn what Americans could do to narrow the life expectancy gap between the United States and other industrialized nations. Coming right up after these summaries.                                 Are microRNAs involved in nitrate tolerance? Well, the first original paper this week provides some answers. This is from co-corresponding authors Dr Bai and Zhang from Central South University in Changsha, China. Nitrate tolerance develops when there's dysfunction of the prostaglandin I2 synthase and prostaglandin I2 deficiency. These authors hypothesize that prostaglandin I2 synthase gene expression may be regulated by a microRNA-dependent mechanism in endothelial cells. They induce nitrovasodilator resistance by nitroglycerin infusion in Apoe deficient mice and studied endothelial function in both the mouse models as well as human umbilical vein endothelial cells. They found that nitric oxide donors induced atopic expression of microRNA 199a/b in endothelial cells, which was required for the nitrovasodilator resistance via repression of prostaglandin I2 synthase gene expression. Targeting this axis effectively improved nitrate tolerance. Thus, the atopic expression of microRNA 199 in endothelial cells induced by nitric oxide may explain prostaglandin I2 synthase deficiency in the progression of nitric tolerance. Thus, microRNA 199a/b may be a novel target for the treatment of nitric tolerance.                                 What are the long-term outcomes of childhood left ventricular noncompaction cardiomyopathy? Well, the next paper presents results from the National Population-Based Study in Australia. First author, Dr Shi, corresponding author, Dr Weintraub, from Royal Children's Hospital in Melbourne, looked at the National Australian Childhood Cardiomyopathy Study, which includes all children in Australia with primary cardiomyopathy diagnosed at less than 10 years of age between 1987 and 1996. Outcomes for left ventricular noncompaction patients with a dilated phenotype will compare to those with a dilated cardiomyopathy.                                 There were 29 patients with left ventricular noncompaction with a mean annual incidence of newly diagnosed cases of 0.11 per hundredth thousand at risks persons.                                 Congestive heart failure was initial symptom in 83%, and 93% had a dilated phenotype. The median age at diagnosis was 0.3 years of age. Freedom from death or transplantation was 48% at 10 years after diagnosis, and 45% at 15 years. Using propensity score inverse probability of treatment-weighted Cox regression, the authors found evidence that left ventricular noncompaction with a dilated phenotype was associated with a more than two-fold greater risk of death or transplantation.                                 The next paper reports the first application of multiomics and network medicine to calcific aortic valve disease. Co-first authors Dr Schlotter and Halu, corresponding author Dr Aikawa from Brigham and Woman's Hospital and Harvard Medical School in Boston, and their colleagues examined 25 human stenotic aortic valves obtained from valve replacement surgeries. They used multiple modalities, including transcriptomics and global unlabeled and label-based tandem-mass-tagged proteomics.                                 Segmentation of valves into disease stage–specific samples was guided by near-infrared molecular imaging. Anatomic-layer specificity was facilitated by laser capture microdissection. Side-specific cell cultures was subjected to multiple calcifying stimuli, and the calcification potential and basil or stimulated proteomics were evaluated. Furthermore, molecular interaction networks were built, and their central proteins and disease associations were identified.                                 The authors found that global transcriptional and protein expression signatures differed between the nondiseased, fibrotic, and calcific stages of calcific aortic valve disease. Anatomical aortic valve microlayers exhibited unique proteome profiles that were maintained throughout disease progression and identified glial fibrillary acidic protein as a specific marker of valvula interstitial cells from the spongiosa layer. In vitro, fibrosa-derived valvular interstitial cells demonstrated greater calcification potential than those from the ventricularis. Analysis of protein-protein interaction networks further found a significant closeness to multiple inflammatory and fibrotic diseases. This study is significant because it is the first application of spatially and temporarily resolved multiomics and network systems biology strategy to identify molecular regulatory networks in calcific aortic valve disease. It provides network medicine–based rational for putative utility of antifibrotic and anti-inflammatory therapies in the treatment of calcific aortic valve disease. It also sets a roadmap for the multiomic study of complex cardiovascular diseases.                                 The final paper tackles the controversy of antibiotic prophylaxis for the prevention of infective endocarditis during invasive dental procedures. This is from a population-based study in Taiwan. First author, Dr Chen, corresponding author, Dr Tu from Institute of Epidemiology and Preventive Medicine College of Public Health in National Taiwan University aimed to estimate the association between invasive dental treatments and infective endocarditis using the health insurance database in Taiwan.                                 They chose 2 case-only study designs. First a case-crossover, and second, self-controlled case series. Both designs used within-subject comparisons such that confounding factors were implicitly adjusted for. They found that invasive dental treatments did not appear to be associated with a larger risk of infective endocarditis in the short period following invasive dental treatment. Results were consistent from both study designs. The authors also did not find any association between invasive dental treatments and infective endocarditis even among the high-risk patients, such as those with a history of rheumatic disease or valve replacement.                                 In summary, these authors found no evidence to support antibiotic prophylaxis for the prevention of infective endocarditis before invasive dental treatments in the Taiwanese population. Whether antibiotic prophylaxis is necessary in other populations requires further study.                                 Alright, so that wraps it up for our summaries, now for our feature discussion.                                 The United States is one of the wealthiest nations worldwide, but Americans have a shorter life expectancy compared with almost all other high-income countries. In fact, the US ranks only 31st in the world for life expectancy at birth in 2015. What are the factors that contribute to premature mortality and life expectancy in the US? Well, today's feature paper gives us some answers. And I'm just delighted to have with us the corresponding author, Dr Frank Hu from Harvard T.H. Chan School of Public Health, as well as our dear associate editor, Dr Jarett Berry, from UT Southwestern.                                 Frank, could you begin by telling us a bit more about the inspiration for looking at this, what you did, and what you found? Dr Frank Hu:       So, we look at the impact of healthy lifestyle habits, life expectancy in the US as a nation. As you just mentioned, Americans have a shorter life expectancy compared with almost all other high-income countries, so in this study we wanted to estimate what kind of impact of lifestyle factors have, premeasured that and life expectancy in the US population.                                 What we did is to combine three datasets. One is our large cohort, Nurses’ Health Study, and Health Professionals Follow-Up Study. We use this large cohort to estimate the relationships between lifestyle habits and mortality. And the second data set we use is to get age and sex to specific mortality rates in the US as a nation. This is the CDC WONDER dataset. And the third dataset we used is the NHANES dataset, this is the National Health and Nutrition Examination Survey. We used this dataset to get the prevalence of healthy lifestyle factors in the general US as a nation. So, we used the three datasets to create age-specific, sex-specific life tables and estimated life expectancies.                                 At age 50, according to the number of healthy lifestyle habits that people would follow, what we found is that following several lifestyle factors can make a huge difference in life expectancies.                                 Here we talk about five basic lifestyle factors: not smoking, maintaining a healthy weight, exercise regularly—at least a half hour per day—and eating a healthy diet, and not drinking too much alcohol. No more than one drink per day for a woman, no more than two drinks per day for men. What we found is that, compared with people who did not adapt any of those low-risk habits, we estimated that the life expectancy at age 50 was 29 years for woman and about 26 years for men. But for people who adapted all five healthy lifestyle habits, life expectancy at age 50 was 43 years for women and 38 years for men. So, in other words, a woman who maintains all 5 healthy habits gained, on average, 14 years of life, and the men who did so gained 12 years life compared with those who didn't maintain healthy lifestyle habits. So I think this is a very important public health message. It means that following several bases of healthy factors can add substantial amount of life expectancy to the US population, and this could help to reduce the gap in life expectancy between the US population and other developed countries. Dr Carolyn Lam: Thank you, Frank. You know that is such an important public health message that I am going to repeat it. Adhering to five lifestyle risk factors mainly, don't smoke, maintain a healthy weight, have regular physical activity, maintain a healthy diet, and have moderate alcohol consumption, AND a woman could increase her life expectancy at age 50 by 14 years and a man could do that by 12 years more. That is absolutely amazing.                                 Okay so Frank, actually, I do have a question though. These are remarkable datasets obviously, but they also go back to the 1980s. So did you see any chief risk factor that may have played more predominant apart with time? Dr Frank Hu:       We didn't specifically look at the changes in risk factors life expectancy, but among the five risk factors, not smoking is certainly the most important factor in terms of improving life expectancy. The good news is that prevalent smoking in the US has decreased substantially in the past several decades. However, the prevalence of other risk factors has actually increased. For example, the prevalence of obesity has increased two- or three-fold and the prevalence of regular exercise remained at a very low level, and also the diet quality in the US population is relatively poor. So, the combination of those risk factors have contributed to relatively low life expectancies in the US population. Dr Carolyn Lam: Right. Obesity, not smoking, I hear you. I just wanted to point out to all the listeners too, you have to take a look at Figure 1 of this beautiful paper, it’s just so beautifully illustrated in it.                                 Jarett, you helped to manage and bring this paper through. What are your thoughts? Dr Jarett Berry: Yeah, I just want to echo your comments, Carolyn, and Dr Hu. This is a fabulous paper, and a very important contribution characterizing these important associations in the US population. And I think, and the discussion thus far has been really helpful in putting all of this into context.                                 I do want to ask you, just a couple of, I guess more, philosophical questions about some of the observations in the paper. And one of them is the prevalence of the low-risk factor, those with a large number of low-risk factors, for example, in both the Nurses Health and in the Health Professional Follow-Up Study, you observed that the presence of five lifestyle factors was less than 2%. And it's interesting you see this in a large number of datasets and I think important, maybe for our readers to realize that there's two sides to the coin here.                                 One, the benefit of these low risk factors, but also, unfortunately, the low prevalence of these collections of healthy lifestyle factors that you've outlined.                                 Could you comment a little bit on that, and what that means, both maybe from a scientific point of view of perhaps, more importantly, from a public health stand point? Dr Frank Hu:       Yeah and this is very important observation and the number of people or the percentage of people who maintained all the five low-risk lifestyle habits is quite low in our cohort, even the nurses and health professionals, they are more health conscience in the general population. They have much better access to health care and also better access to healthy foods and have physical activity facilities. Despite all this potential advantages, and these more percentage of people who are able to maintain all five lifestyle risk factors.                                 On the other hand, about 10 to 15% of our participants did not adopt any of the five low-risk lifestyle habits. So it means that we still have a lot of work to do in terms of improving the lifestyle habits that we discussed earlier. The five risk lifestyle factors and in the general population, I think the percentage of people who adapt all the five lifestyle factors, probably even lower than 2%. And so that means that we have a huge public health challenge in front of us and have to improving the five lifestyle risk factors. One of the most important public health challenges as mentioned earlier is obesity because currently we have two-third of the US population is overweight or obese. So that's something I think is major public health challenges for us. Dr Jarett Berry: Right, and it’s interesting looking at your Table 1, and those individuals who have all five low risk factors. It's interesting that the prevalence of physical activity was incredibly high. I have a great interest of impact of exercise on these types of outcomes and it's interesting that in both cohorts, six or seven hours a week of exercise was the mean physical activity level in those with five risk factors. So, it's interesting and in some ways, these lifestyle factors, they do tend to congregate or covary with one another such that those individuals who do spend that kind of time, albeit unfortunately more rare than we would like to see it, the increase in physical activity does tend to have a positive impact, not only on the weight, but also on healthy lifestyle or healthy diet choices. Dr Frank Hu:       Right, yeah this is a very good observation that what I do want to point out that our definition of regular exercise is pretty cerebral to put it in terms of the definition. So we define moderate to vigorous physical activity in our cohorts. We included not just running, playing sports, but it was also walking in a moderate intensity. So it means that people can incorporate physical activity into their daily life. For example, by walking from a train station and with climbing stairs in their workplace and so on and so forth. So here physical activity means both recreational activity and also moderate intensity activities such as graceful walking. Dr Carolyn Lam: Frank, I think both of us listening are breathing a sigh of relief there and just for the listeners to understand too. These factors were dichotomized, right, and so you were describing the type of exercise and actually you used a three and a half hour per week limit to define healthy or not.                                 Similarly, just for reference the alcohol intake was 5 to 15g a day for women, or 5 to 30g a day for men. And normal weight was defined as a BMI of 18.5 to 24.9. I'm just thinking that if I were listening I'd want to know those cutoffs.                                 Now, can I ask a follow-up question, therefore to this dichotomy. As far as I understand you counted each of these risk factors equally, but did you try to do a weighted analysis by any chance? Did any one of them play a bigger role than others? Dr Frank Hu:       That's an interesting mathematical question because it’s very difficult to assign different weights to different risk factors because we look at, not just total mortality but also cardiovascular mortality and cancer mortality. So, you would have to use different weights for different causes of mortality. That would make the analysis much more complicated. But we did calculate a different type of score using five categories of each risk factor and then using that score, we were able to rank people in more categories so for that score the range is from five to 25, and we categorized people into quintiles or even more categories and the contrast in life expectancy between the lowest and the highest group is even greater. So, it means that, the higher number of healthy lifestyle factors, the greater life expectancy. Also, with each category, each lifestyle factors a high degree of adherence to that factor, the greater health benefit people will get. So, I think it's really accumulative fact of multiple risk factors and also the degree of adherence to each of the factors. Dr Carolyn Lam: Again, such an important public health message.                                 Jarett, how do you think this is going to be received by the public at large? Dr Jarett Berry: Very well received. I mean this is a very important observation demonstrating some of these disconcerting observations about life expectancy in the United States and as we think about strategies for improving the public health, I think Dr Hu's group has really helped us outline, very clearly, what other bodies such as the American Heart Association have been saying for years now, that lifestyle factors are so important in influencing cardiovascular risk, and in this case, life expectancy. It really does put, once again, the right amount of emphasis on the role these lifestyle factors of improving the public health. I think it’s going to be very well received and really helpful and important observation that all of us need to hear. Dr Carolyn Lam: Listeners, don't forget this important message and tell your friends about it, please.                                 Thanks for joining us today, don't forget to join us again next week.  

Want to know how to keep the weight off after successfully losing it? In this podcast, Tracy Herbert shares strategies to keep the weight off for the rest of your life. Below is a link to the 2008 Nurses Health Study on the importance of sleep for weight loss: https://www.ncbi.nlm.nih.gov/pubmed/18239586?dopt=Citation Here is a link to my podcast on sleep: http://yourdiabetesbreakthrough.com/035 How to connect with Tracy: https://www.tracyherbert.com/contact-tracy/

This audio summary reviews a cohort study that uses Nurses’ Health Study data to investigate associations between diethylstilbestrol (DES) use in pregnancy and self-reported development of ADHD in grandchildren.

Day 05: Cook a meal with a vegetable you have never tried before.EVegetables and fruits are an important part of a healthy diet, and variety is as important as quantity.No single fruit or vegetable provides all of the nutrients you need to be healthy. Eat plenty everyday.A diet rich in vegetables and fruits can lower blood pressure, reduce risk of heart disease and stroke, prevent some types of cancer, lower risk of eye and digestive problems, and have a positive effect upon blood sugar which can help keep appetite in check.Eat a variety of types and colors of produce in order to give your body the mix of nutrients it needs. Try dark leafy greens; brightly colored red, yellow and orange vegetables and fruits; and cooked tomatoes.Eat more vegetables and fruits each day1. Keep fruit where you can see it. That way you’ll be more likely to eat it.2. Explore the produce aisle and choose something new. Variety is the key to a healthy diet.3. Skip the potatoes. Choose other vegetables that are packed with more nutrients and more slowly digested carbohydrates.4. Make it a meal. Try cooking new recipes that include more vegetables. Salads and stir fries are two ideas for getting tasty vegetables on your plate.Vegetables, fruits, and diseaseCardiovascular diseaseThere is compelling evidence that a diet rich in fruits and vegetables can lower the risk of heart disease and stroke. The largest and longest study to date, done as part of the Harvard-based Nurses’ Health Study and Health Professionals Follow-up Study, included almost 110,000 men and women whose health and dietary habits were followed for 14 years.The higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease. Compared with those in the lowest category of fruit and vegetable intake (less than 1.5 servings a day), those who averaged 8 or more servings a day were 30 percent less likely to have had a heart attack or stroke. (1)Although all fruits and vegetables likely contribute to this benefit, green leafy vegetables such as lettuce, spinach, Swiss chard, and mustard greens; cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy, and kale; and citrus fruits such as oranges, lemons, limes, and grapefruit (and their juices) make important contributions. (1)When researchers combined findings from the Harvard studies with several other long-term studies in the U.S. and Europe, and looked at coronary heart disease and stroke separately, they found a similar protective effect: Individuals who ate more than 5 servings of fruits and vegetables per had roughly a 20 percent lower risk of coronary heart disease (2) and stroke, (3) compared with individuals who ate less than 3 servings per day.Blood pressureThe Dietary Approaches to Stop Hypertension (DASH) study (4) examined the effect on blood pressure of a diet that was rich in fruits, vegetables, and low-fat dairy products and that restricted the amount of saturated and total fat. The researchers found that people with high blood pressure who followed this diet reduced their systolic blood pressure (the upper number of a blood pressure reading) by about 11 mm Hg and their diastolic blood pressure (the lower number) by almost 6 mm Hg—as much as medications can achieve.A randomized trial known as the Optimal Macronutrient Intake Trial for Heart Health (OmniHeart) showed that this fruit and vegetable-rich diet lowered blood pressure even more when some of the carbohydrate was replaced with healthy unsaturated fat or protein. (5)In 2014 a meta-analysis of clinical trials and observational studies found that consumption of a vegetarian diet was associated with lower blood pressure (19).CancerNumerous early studies revealed what appeared to be a strong link between eating fruits and vegetables and protection against cancer. Unlike case-control studies, cohort studies, which follow large groups of initially healthy individuals for years, generally provide more reliable information than case-control studies because they don’t rely on information from the past. And, in general, data from cohort studies have not consistently shown that a diet rich in fruits and vegetables prevents cancer.For example, in the Nurses’ Health Study and the Health Professionals Follow-up Study, over a 14-year period, men and women with the highest intake of fruits and vegetables (8+ servings a day) were just as likely to have developed cancer as those who ate the fewest daily servings (under 1.5). (1)Metamorphus is an organization dedicated to helping people using modern day tools in a world that's always changing. Our goal is to provide a free and accessible resource to those suffering from mental health worldwide. Together, we can revolutionize the mental health crisis that is unfolding today with your help. You can expect helpful content like: - Daily Lifestyle Challenges- Introspective Interviews with Leading Professionals- Healthy Living Tips & Advice- Personal Mental Health Struggle StoriesPlease contact us if you would like to chat, feedback, and guest queries. Email - info@metamorphus.orgWebsite - metamorphus.orgFollow Us on Social Media Instagram - https://www.instagram.com/metamorphus_org/Twitter - https://twitter.com/Metamorphus_OrgFacebook - https://www.facebook.com/Metamorphus.org/Mark Metry - https://www.instagram.com/markmetry/Brendan Cutuli - https://www.instagram.com/cutulib/

Day 05: Cook a meal with a vegetable you have never tried before.EVegetables and fruits are an important part of a healthy diet, and variety is as important as quantity.No single fruit or vegetable provides all of the nutrients you need to be healthy. Eat plenty everyday.A diet rich in vegetables and fruits can lower blood pressure, reduce risk of heart disease and stroke, prevent some types of cancer, lower risk of eye and digestive problems, and have a positive effect upon blood sugar which can help keep appetite in check.Eat a variety of types and colors of produce in order to give your body the mix of nutrients it needs. Try dark leafy greens; brightly colored red, yellow and orange vegetables and fruits; and cooked tomatoes.Eat more vegetables and fruits each day1. Keep fruit where you can see it. That way you’ll be more likely to eat it.2. Explore the produce aisle and choose something new. Variety is the key to a healthy diet.3. Skip the potatoes. Choose other vegetables that are packed with more nutrients and more slowly digested carbohydrates.4. Make it a meal. Try cooking new recipes that include more vegetables. Salads and stir fries are two ideas for getting tasty vegetables on your plate.Vegetables, fruits, and diseaseCardiovascular diseaseThere is compelling evidence that a diet rich in fruits and vegetables can lower the risk of heart disease and stroke. The largest and longest study to date, done as part of the Harvard-based Nurses’ Health Study and Health Professionals Follow-up Study, included almost 110,000 men and women whose health and dietary habits were followed for 14 years.The higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease. Compared with those in the lowest category of fruit and vegetable intake (less than 1.5 servings a day), those who averaged 8 or more servings a day were 30 percent less likely to have had a heart attack or stroke. (1)Although all fruits and vegetables likely contribute to this benefit, green leafy vegetables such as lettuce, spinach, Swiss chard, and mustard greens; cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy, and kale; and citrus fruits such as oranges, lemons, limes, and grapefruit (and their juices) make important contributions. (1)When researchers combined findings from the Harvard studies with several other long-term studies in the U.S. and Europe, and looked at coronary heart disease and stroke separately, they found a similar protective effect: Individuals who ate more than 5 servings of fruits and vegetables per had roughly a 20 percent lower risk of coronary heart disease (2) and stroke, (3) compared with individuals who ate less than 3 servings per day.Blood pressureThe Dietary Approaches to Stop Hypertension (DASH) study (4) examined the effect on blood pressure of a diet that was rich in fruits, vegetables, and low-fat dairy products and that restricted the amount of saturated and total fat. The researchers found that people with high blood pressure who followed this diet reduced their systolic blood pressure (the upper number of a blood pressure reading) by about 11 mm Hg and their diastolic blood pressure (the lower number) by almost 6 mm Hg—as much as medications can achieve.A randomized trial known as the Optimal Macronutrient Intake Trial for Heart Health (OmniHeart) showed that this fruit and vegetable-rich diet lowered blood pressure even more when some of the carbohydrate was replaced with healthy unsaturated fat or protein. (5)In 2014 a meta-analysis of clinical trials and observational studies found that consumption of a vegetarian diet was associated with lower blood pressure (19).CancerNumerous early studies revealed what appeared to be a strong link between eating fruits and vegetables and protection against cancer. Unlike case-control studies, cohort studies, which follow large groups of initially healthy individuals for years, generally provide more reliable information than case-control studies because they don’t rely on information from the past. And, in general, data from cohort studies have not consistently shown that a diet rich in fruits and vegetables prevents cancer.For example, in the Nurses’ Health Study and the Health Professionals Follow-up Study, over a 14-year period, men and women with the highest intake of fruits and vegetables (8+ servings a day) were just as likely to have developed cancer as those who ate the fewest daily servings (under 1.5). (1)Metamorphus is an organization dedicated to helping people using modern day tools in a world that's always changing. Our goal is to provide a free and accessible resource to those suffering from mental health worldwide. Together, we can revolutionize the mental health crisis that is unfolding today with your help. You can expect helpful content like: - Daily Lifestyle Challenges- Introspective Interviews with Leading Professionals- Healthy Living Tips & Advice- Personal Mental Health Struggle StoriesPlease contact us if you would like to chat, feedback, and guest queries. Email - info@metamorphus.orgWebsite - metamorphus.orgFollow Us on Social Media Instagram - https://www.instagram.com/metamorphus_org/Twitter - https://twitter.com/Metamorphus_OrgFacebook - https://www.facebook.com/Metamorphus.org/Mark Metry - https://www.instagram.com/markmetry/Brendan Cutuli - https://www.instagram.com/cutulib/

„Warum in den USA sich der Wohlstand nicht in Wohlergehen verwandelt, haben Wissenschaftler nun in einer großen Studie untersucht. Sie wurde in der Fachzeitschrift „Circulation“ veröffentlicht. Die Forscher haben dafür sehr viele Daten ausgewertet, unter anderem zweier sehr großer und berühmter Gesundheitskohorten-Studien: In der Nurses’ Health Study werden seit 1976 alle zwei Jahre Krankenschwestern nach […]

Making all your nephrology dreams come true with part 2 of our interview with  @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Flush away your bad prescribing habits when it comes to nephrotoxic drugs in this fast paced run down of the medications which must stay on or off Santa’s naughty-list, backed up with a sack full of memorable research studies. Special thanks to Annie Medina, Justin Berk and Kate Grant for writing/producing this show and to physician artist, Kate Grant for her lovely/hilarious artwork (more at paintscientific.com). Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 03:00 Which medications should we exercise caution over in CKD? 03:31 Bactrim (Trimethoprim+Sulfamethoxazole) 07:00 NSAIDS 08:29 NSAIDS and the ‘Precision’ Trial NEJM 2016 looking at cardiovascular safety 12:50 The Male Physician Study JAMA 2001 13:50 Discussion about Nurses Health Study and use of analgesia, and CKD 15:15 Acute Interstitial Nephritis, Beta Lactam Antibiotics, and the risk of Acute kidney injury +/- CKD with Proton Pump Inhibitors 18:20 Advice for co-prescribing NSAIDS,ACE inhibitors and diuretics 20:39 Creatinine levels and ACE/ARB prescribing. How High can you go? 24:55 Facebook question from listener: measures to reduce proteinuria in hypertensive patients 27:20 Empagliflozin and renal protection in diabetic patients 32:00 Contrast Induced Nephropathy, the AMACING trial 2016. 38:00 Take Home Points 39:57 Outro Tags:  chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, medications, pharmacology, bactrim, nsaids, ace-i, contrast, metformin, empagliflozin, nephropathy, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student  

Join Our Beta Program Community - Here! ---- The gene that we are going to be taking a closer look at this week is TCF7L2. This gene creates a protein called transcription factor 7-like 2, which in turn binds to other genes to alter their expression. It has been shown through research to have an impact on how well you tolerate carbohydrates, and how well you tolerate saturated fat, which is how we report on it in the My DNA Coach reports. With regards to carbohydrates sensitivity, the TCF7L2 gene appears to play a role in the development of type-II diabetes, potentially through impairment on insulin sensitivity. Many studies have reported this association, including one by Cornelis et al., published in 2009. In this study, the researchers recruited just over 3,000 nurses from a much larger longitudinal study taking place in the USA, called the Nurses Health Study (NHS). Of these 3000 subjects, 1140 had developed type-II diabetes, and the rest had not. As part of the NHS, which started in 1976 and recruited 121,700 female nurses, everyone involved was sent questionnaires every two years. These questionnaires often asked questions about food intake, and what the typical dietary habits of the nurses was like. From this, it was possible to find out not only how much fat, carbohydrate, and protein was typically consumed by these nurses, but also the type of each; of special interest to us in this case in the type of carbohydrate consumed – low Glycaemic Index (GI) or high GI. This allowed the researchers to see if there was an association with type of carbohydrates and the development of type-II diabetes, but also to see if this associated was enhanced or reduced by differences in the TCF7L2 gene. So what did they find? Firstly, a high-GI diet was found to be slightly more likely to cause the development of type-II diabetes than a low carbohydrate diet, which goes along with what we already know. However, when looking at TF7L2 genotype, this effect was much larger. Those nurses with two copies of the risk allele and following a diet with a high glycaemic index were 2.7 times more likely to develop type-II diabetes than those with no risk alleles. With a low-GI diet, this risk was significantly reduced. It makes sense, therefore, that those carrying a risk allele of TCF7L2 should consume a diet with an overall low GI, prioritising carbohydrates from fibrous vegetables over simple sugars and refined carbohydrates. Other studies have shown that high saturated fat intake along with having at least one T allele increases the risk of having a reduction in insulin sensitivity. The effects of TCF7L2 can be summarised as so: TCF7L2 Genotype Effect on Carbohydrate / Saturated Fat Sensitivity Dietary Modification CC No increased sensitivity to refined carbohydrates or saturated fat Follow standard guidelines CT Moderately increased sensitivity to both refined carbohydrates and saturated fats Aim to get carbohydrates primarily from fibrous sources, such as vegetables, and limit saturated fat slightly. TT Associated with a significantly increased sensitivity to refined carbohydrates and saturated fat Prioritise fibrous carbohydrates and limit refined carbohydrates. Consume lower amounts of saturated fats. Time Stamped Show Notes: 0:57 – The gene we will be taking a closer look at this week is TCFL72. 1:00 – This gene creates a protein called transcription factor 7-like 2 which has an impact on how well you tolerate carbohydrates and saturated fat. 1:23 – The TCFL72 gene appears to play a role in the development of Type II diabetes,  potentially through the impairment of insulin sensitivity. 1:32 – There have been several studies about this. 1:34 – 2009 study of 3000 nurses – Nurses Health Study 1:45 – This study allowed researchers to see if there was a connection between the types of carbohydrates consumed (low vs high GI) and Type II diabetes and if this was enhanced or reduced by differences in the TCFL72 gene. 2:57 – A high GI diet is slightly more likely to cause the development of Type II diabetes than a low GI diet. 3:08 - This risk of developing Type II diabetes is 2.7 times higher in those with two risk alleles than those with no risk alleles. 3:32 – This risk significantly reduced by consuming a low GI diet. 3:36 – Therefore, those with risk alleles should consume a low GI diet, prioritizing carbohydrates from vegetables over those from simple sugars. 3:51 – Other studies have shown that high saturated fat intake along with having at least one T allele increases the risk of having a reduction in insulin sensitivity. 4:05 - The effects of TCF7L2 can be summarised as so: 4:18 – CC – no increase in sensitivity – You should follow standard dietary guidelines. 4:29 – CT – moderate increase in sensitivity - Aim to get carbohydrates primarily from fibrous sources, such as vegetables, and limit saturated fat slightly. 4:45: TT – significant increase in sensitivity - Prioritise fibrous carbohydrates and limit refined carbohydrates. Consume lower amounts of saturated fats. 5:05 – We take all this information from your report and combine it with our unique curriculum process 5:27 – In this case, knowledge alone isn’t power – execution is power. 5:36 – You must have a system in place to help you implement what you learn from your genetics report. 6:03 – Jonny closes the episode. Resources Mentioned: https://www.ncbi.nlm.nih.gov/pubmed/19211816 https://www.ncbi.nlm.nih.gov/pubmed/21543200

A recent study found that being overweight or obese throughout adulthood is associated with increased risk of sudden cardiac death.A study recently published in JACC: Clinical Electrophysiology found that being overweight or obese while in adulthood contributed to an increased risk of sudden cardiac death. Researchers used data from the Nurses’ Health Study, which looked at 72,484 women during a 32-year span (1980 to 2012). Researchers looked at the relation between body mass index (BMI) and weight gain and the risk for sudden cardiac death, death from coronary heart disease, and non-fatal heart attacks. What did the researchers find? Over the 32-year period of the study, researchers found 445 cases of sudden cardiac death, 1,286 cases of fatal coronary heart disease, and 2,272 non-fatal heart attacks.John Higgins, MD, joins Melanie Cole, MS, to discuss the study and how being overweight and/or obese can cause an increase of cardiac death.

[intro music] Host – Dan Keller Hello, and welcome to Episode Sixty-Three of Multiple Sclerosis Discovery, the Podcast of the MS Discovery Forum. I’m Dan Keller. We’ve just passed the winter solstice. What better time than the shortest daylight hours of the year to check in with research at the University of British Columbia on sunlight and MS? Today we talk with Dr. Helen Tremlett who is exploring sun exposure over a person’s life course and how that syncs with their MS risk and disease course. In the weekly papers section on the MS Discovery Forum, this week’s list includes nearly 150 newly published research reports that could lead to better understanding and treatment of MS and related disorders. We selected four papers as editor’s picks. In one paper, researchers think they may have the first experimental evidence that MS may start with damage or loss of myelin-making cells in the brain and spinal cord. In this new mouse model of progressive MS, experimentally damaged brain cells make it hard for the mice to walk. The mice recover when their brain cells repair on their own. Six months later, the MS-like disease returns. In the study, the team showed that nanoparticles targeting the autoimmune reaction prevent the second phase of the disease. The study shows support for an “inside-out” model of MS. That’s different from the “outside-in” model, in which some aspect about the immune system goes wrong and then initiates the attack on myelin-making cells. The paper is published in Nature Neuroscience by collaborating researchers from Northwestern University and the University of Chicago. To grow and be healthy, all human cells need a signaling molecule named mTOR, named for the mammalian target of rapamycin. That’s true for myelin-making cells, or oligodendrocytes, as listeners may remember from an earlier podcast interview with Dr. Wendy Macklin. The ability to make myelin seems to depend on a key part known as mTOR complex 1, also called its raptor subunit. In a very basic advance, scientists have determined the atomic architecture of the raptor, or mTORC1, piece. The details are reported in the journal Science and provide a structural basis for studying mTORC1 function. In another editor’s pick, a review of cases of pediatric neuromyelitis optica, or NMO, showed that new international diagnostic guidelines applied well to children. Unfortunately, they also found that children with NMO have delayed treatment and worse short-term outcomes compared to those with MS. The authors urged immediate adoption of the guidelines to select the best treatment and improve outcomes. In the fourth editor’s pick, researchers found a potential new target to protect axons in a mouse model of neurodegeneration in multiple sclerosis. The target is a pore in the mitochondria, the cellular battery that provides energy. They designed a molecule to block the pore and showed it helped protect neurons and improved the mice’s mobility, all with minimal immunosuppression. The paper by mostly UK researchers is published in the Journal of Biological Chemistry. Now, let’s take a look at the latest Drug Development Pipeline updates. The drugs with important additions and changes are dimethyl fumarate, fingolimod, glatiramer acetate, natalizumab, and rituximab. One update reflects findings from post-hoc analysis of clinical trial data showing that the positive effects of fingolimod are apparent quite soon –within months – after initiation of treatment. [transition music] And now to our interview. I spoke with Professor Helen Tremlett, Canada research chair in neuroepidemiology and multiple sclerosis at the University of British Columbia when we were at the ECTRIMS conference in Barcelona in October. She has been studying sun exposure over the course of the lifetime and its relation to MS risk. While MS may affect an individual's likelihood to go out in the sun, studies may also need to consider the influence of sun exposure before the disease develops. Interviewer – Dan Keller What are you doing in this area? Interviewee – Helen Tremlett So I was presenting at ECTRIMS yesterday on a really interesting study based out of the Nurses' Health Study, and this was a collaboration from my group in Vancouver and Harvard School of Public Health; and that's Alberto Ascherio's group and Sandy Munger. So we were looking at sun exposure over the life course and associations with multiple sclerosis. So here we were looking at both aspects of the spectrum, if you can imagine; we were looking at sun exposure and future risk of multiple sclerosis, but also once an individual has developed multiple sclerosis, we were looking at the impact that potentially has on an individual in terms of their propensity to go outdoors in the daylight hours, outdoors in the sun. MSDF Right. So it may be the cart is before the horse in that sense; not that sun exposure is causing it, but their disability is causing less sun exposure? Dr. Tremlett We were looking at both sides of the equation. And I think it is important, particularly in a disease such as MS where onset of MS is a little bit fuzzy, I think, to look at sun exposure of the life course is important, and certainly our findings are indicating that. Because you want to know sunlight exposure in MS risk, but you also want to know, once someone's developed multiple sclerosis, how that influences their behavior outdoors and what implications that has if you're then trying to design the study to look at what causes MS. You need to be really careful who you recruit, because if that person has already changed their behavior, then that may influence your findings, and you're not then actually looking at what causes MS at all, you're just looking at a consequence of the disease. So I guess that's the first part of why we wanted to do that. And the second part is if having MS, if having a chronic condition, does influence your propensity or ability or desire to go outside, what consequence could that have for your health in terms of maybe your serum vitamin D levels or your melatonin levels, and that may have a consequence in terms of long-term health. MSDF You segmented people by where they were and at what ages. Dr. Tremlett It was pretty interesting. So, first of all, over ages 5 to 15, we found there that there was a 48% lower risk of MS for women living in high, relative to low, ambient UVB areas during their sort of childhood and early adolescent years. So that was pretty interesting. But we found, kind of to our surprise because it goes against other studies that are out there, we found that time spent outdoors in summer or winter wasn't significantly associated with MS risk in that age group, 5 to 15 years. But what we didn't realize is that it wasn't until we combined that outdoor behavior with the UVB, then we could see that there was an association. So we found that less time spent outdoors in summer in low ambient UVB areas—that was associated with a two-fold increased risk of multiple sclerosis. That was an important step for us; I mean, it might, you know, sound obvious to combine those two, but it was an important step because other studies in smaller geographical areas such as Tasmania, or there's a study out of Norway in a small region of Norway, they can find an association between time spent outdoors in summer/winter and MS risk. But I think we couldn't find it in the US, because the US is at such a diversity of latitudes – the study spanned over 14 US states – so it wasn't until we looked at that outdoor behavior in context of ambient UVB that we could find the association. And then, I suppose, our next step was to look at outdoor behavior over the life course. And this was really interesting, that we found some avoidance behavior was apparent in later life in multiple sclerosis. And maybe that comes as no surprise to people, but I think our numbers are interesting to put a concrete figure on it. So, for instance, by age 50, our MS cases were 60% less likely to report high relative to low outdoor exposure compared to controls, and that was in winter and in summer. So the bottom line is people with MS, once they have MS, are not going outside as much, so they're not getting that UVB exposure, so potentially they're not making that vitamin D and serum vitamin D. And then the winter exposure's important as well, because potentially they're not getting the same melatonin production and inhibition, and that may have a really important role in terms of immunology, the circadian rhythm and your sleep cycle, which, again, all knocks back into overall health and immunology of MS. And there have been some presentations actually at this conference looking into melatonin and its association with relapses in MS, and that's pretty interesting. MSDF There's even some emerging thought that sleep is essential for good brain function in terms of taking out the garbage – glymphatics and things like that. So melatonin disturbances may actually have some further consequences in an inflammatory brain disease. Dr. Tremlett And there's some interesting studies, not that we did but others have done, looking at shift work and risk of MS. And shift work may be associated with increased risk of MS. Maybe melatonin ties into that as well. MSDF Is there also potentially an effect, besides on vitamin D and melatonin, that sun exposure itself has an effect on the immune system, maybe suppressing it? Dr. Tremlett Yeah, modulating it in some way. No, absolutely. We don't really know the mechanism. I mean, the obvious one would be sun on human skin at the right time of year on the right skin color can result in really high levels of serum vitamin D being produced. Sunlight exposure the minute it actually hits the skin surface can have a direct immunomodulatory effect. And then, obvious, sun hitting the eye. Melatonin is one of the pathways in there that may then impact the immune system. MSDF Is it possible to make any conclusions or even recommendations at this point? Dr. Tremlett No. It's an observational study, and we do actually need to do more analysis on this group of individuals. The main recommendations we could make from this study is informing how to design future studies, and also two things you could take from this in terms of recommendations. First of all, we saw sun avoidance behavior in individuals once they've developed multiple sclerosis. That's really important because it really means that if you want to look at what is causing MS, do not take serum vitamin D levels or look at skin cancer risk, for instance, in individuals who already have MS, because they've already changed in compare to controls, adding further somehow differences are related to what causes MS, because these individuals have already changed their behavior because they've got a chronic disease. So that's the first statement, which might be a no-brainer for some people, but it's amazing how many studies are still published like that in the MS literature at the moment. And I suppose the second piece is trying to understand if we are going to do an interventional study, what time period in an individual's life or within a population do you need to target in order to change the course and prevent the disease from occurring? And we're trying to understand that more, looking beyond the window age 5 to 15, look more into adulthood to see if ambient UVB is associated with MS risk later in life and into adulthood. And others have shown that there does seem to be an association even into adulthood, which is exciting because if you do want to do an intervention study, then you haven't necessarily missed the boat because you've not intervened during childhood. But, I mean, the real question is how do you intervene and what with? And that's another topic in itself. MSDF We'll leave that for another day. Thank you. Dr. Tremlett Thank you very much. [transition music] Next week, we'll continue our discussion with Professor Tremlett when she'll talk about her preliminary studies on pediatric MS patients and their gut microbiomes. Until then, thank you for listening to Episode Sixty-Three of Multiple Sclerosis Discovery. This Podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Carol Cruzan Morton. Heather McDonald curated the MSDF drug database updates. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations. Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances. We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org. For Multiple Sclerosis Discovery, I'm Dan Keller. [outro music]

[intro music] Host – Dan Keller Hello, and welcome to Episode Sixty-Three of Multiple Sclerosis Discovery, the Podcast of the MS Discovery Forum. I’m Dan Keller. We’ve just passed the winter solstice. What better time than the shortest daylight hours of the year to check in with research at the University of British Columbia on sunlight and MS? Today we talk with Dr. Helen Tremlett who is exploring sun exposure over a person’s life course and how that syncs with their MS risk and disease course. In the weekly papers section on the MS Discovery Forum, this week’s list includes nearly 150 newly published research reports that could lead to better understanding and treatment of MS and related disorders. We selected four papers as editor’s picks. In one paper, researchers think they may have the first experimental evidence that MS may start with damage or loss of myelin-making cells in the brain and spinal cord. In this new mouse model of progressive MS, experimentally damaged brain cells make it hard for the mice to walk. The mice recover when their brain cells repair on their own. Six months later, the MS-like disease returns. In the study, the team showed that nanoparticles targeting the autoimmune reaction prevent the second phase of the disease. The study shows support for an “inside-out” model of MS. That’s different from the “outside-in” model, in which some aspect about the immune system goes wrong and then initiates the attack on myelin-making cells. The paper is published in Nature Neuroscience by collaborating researchers from Northwestern University and the University of Chicago. To grow and be healthy, all human cells need a signaling molecule named mTOR, named for the mammalian target of rapamycin. That’s true for myelin-making cells, or oligodendrocytes, as listeners may remember from an earlier podcast interview with Dr. Wendy Macklin. The ability to make myelin seems to depend on a key part known as mTOR complex 1, also called its raptor subunit. In a very basic advance, scientists have determined the atomic architecture of the raptor, or mTORC1, piece. The details are reported in the journal Science and provide a structural basis for studying mTORC1 function. In another editor’s pick, a review of cases of pediatric neuromyelitis optica, or NMO, showed that new international diagnostic guidelines applied well to children. Unfortunately, they also found that children with NMO have delayed treatment and worse short-term outcomes compared to those with MS. The authors urged immediate adoption of the guidelines to select the best treatment and improve outcomes. In the fourth editor’s pick, researchers found a potential new target to protect axons in a mouse model of neurodegeneration in multiple sclerosis. The target is a pore in the mitochondria, the cellular battery that provides energy. They designed a molecule to block the pore and showed it helped protect neurons and improved the mice’s mobility, all with minimal immunosuppression. The paper by mostly UK researchers is published in the Journal of Biological Chemistry. Now, let’s take a look at the latest Drug Development Pipeline updates. The drugs with important additions and changes are dimethyl fumarate, fingolimod, glatiramer acetate, natalizumab, and rituximab. One update reflects findings from post-hoc analysis of clinical trial data showing that the positive effects of fingolimod are apparent quite soon –within months – after initiation of treatment. [transition music] And now to our interview. I spoke with Professor Helen Tremlett, Canada research chair in neuroepidemiology and multiple sclerosis at the University of British Columbia when we were at the ECTRIMS conference in Barcelona in October. She has been studying sun exposure over the course of the lifetime and its relation to MS risk. While MS may affect an individual's likelihood to go out in the sun, studies may also need to consider the influence of sun exposure before the disease develops. Interviewer – Dan Keller What are you doing in this area? Interviewee – Helen Tremlett So I was presenting at ECTRIMS yesterday on a really interesting study based out of the Nurses' Health Study, and this was a collaboration from my group in Vancouver and Harvard School of Public Health; and that's Alberto Ascherio's group and Sandy Munger. So we were looking at sun exposure over the life course and associations with multiple sclerosis. So here we were looking at both aspects of the spectrum, if you can imagine; we were looking at sun exposure and future risk of multiple sclerosis, but also once an individual has developed multiple sclerosis, we were looking at the impact that potentially has on an individual in terms of their propensity to go outdoors in the daylight hours, outdoors in the sun. MSDF Right. So it may be the cart is before the horse in that sense; not that sun exposure is causing it, but their disability is causing less sun exposure? Dr. Tremlett We were looking at both sides of the equation. And I think it is important, particularly in a disease such as MS where onset of MS is a little bit fuzzy, I think, to look at sun exposure of the life course is important, and certainly our findings are indicating that. Because you want to know sunlight exposure in MS risk, but you also want to know, once someone's developed multiple sclerosis, how that influences their behavior outdoors and what implications that has if you're then trying to design the study to look at what causes MS. You need to be really careful who you recruit, because if that person has already changed their behavior, then that may influence your findings, and you're not then actually looking at what causes MS at all, you're just looking at a consequence of the disease. So I guess that's the first part of why we wanted to do that. And the second part is if having MS, if having a chronic condition, does influence your propensity or ability or desire to go outside, what consequence could that have for your health in terms of maybe your serum vitamin D levels or your melatonin levels, and that may have a consequence in terms of long-term health. MSDF You segmented people by where they were and at what ages. Dr. Tremlett It was pretty interesting. So, first of all, over ages 5 to 15, we found there that there was a 48% lower risk of MS for women living in high, relative to low, ambient UVB areas during their sort of childhood and early adolescent years. So that was pretty interesting. But we found, kind of to our surprise because it goes against other studies that are out there, we found that time spent outdoors in summer or winter wasn't significantly associated with MS risk in that age group, 5 to 15 years. But what we didn't realize is that it wasn't until we combined that outdoor behavior with the UVB, then we could see that there was an association. So we found that less time spent outdoors in summer in low ambient UVB areas—that was associated with a two-fold increased risk of multiple sclerosis. That was an important step for us; I mean, it might, you know, sound obvious to combine those two, but it was an important step because other studies in smaller geographical areas such as Tasmania, or there's a study out of Norway in a small region of Norway, they can find an association between time spent outdoors in summer/winter and MS risk. But I think we couldn't find it in the US, because the US is at such a diversity of latitudes – the study spanned over 14 US states – so it wasn't until we looked at that outdoor behavior in context of ambient UVB that we could find the association. And then, I suppose, our next step was to look at outdoor behavior over the life course. And this was really interesting, that we found some avoidance behavior was apparent in later life in multiple sclerosis. And maybe that comes as no surprise to people, but I think our numbers are interesting to put a concrete figure on it. So, for instance, by age 50, our MS cases were 60% less likely to report high relative to low outdoor exposure compared to controls, and that was in winter and in summer. So the bottom line is people with MS, once they have MS, are not going outside as much, so they're not getting that UVB exposure, so potentially they're not making that vitamin D and serum vitamin D. And then the winter exposure's important as well, because potentially they're not getting the same melatonin production and inhibition, and that may have a really important role in terms of immunology, the circadian rhythm and your sleep cycle, which, again, all knocks back into overall health and immunology of MS. And there have been some presentations actually at this conference looking into melatonin and its association with relapses in MS, and that's pretty interesting. MSDF There's even some emerging thought that sleep is essential for good brain function in terms of taking out the garbage – glymphatics and things like that. So melatonin disturbances may actually have some further consequences in an inflammatory brain disease. Dr. Tremlett And there's some interesting studies, not that we did but others have done, looking at shift work and risk of MS. And shift work may be associated with increased risk of MS. Maybe melatonin ties into that as well. MSDF Is there also potentially an effect, besides on vitamin D and melatonin, that sun exposure itself has an effect on the immune system, maybe suppressing it? Dr. Tremlett Yeah, modulating it in some way. No, absolutely. We don't really know the mechanism. I mean, the obvious one would be sun on human skin at the right time of year on the right skin color can result in really high levels of serum vitamin D being produced. Sunlight exposure the minute it actually hits the skin surface can have a direct immunomodulatory effect. And then, obvious, sun hitting the eye. Melatonin is one of the pathways in there that may then impact the immune system. MSDF Is it possible to make any conclusions or even recommendations at this point? Dr. Tremlett No. It's an observational study, and we do actually need to do more analysis on this group of individuals. The main recommendations we could make from this study is informing how to design future studies, and also two things you could take from this in terms of recommendations. First of all, we saw sun avoidance behavior in individuals once they've developed multiple sclerosis. That's really important because it really means that if you want to look at what is causing MS, do not take serum vitamin D levels or look at skin cancer risk, for instance, in individuals who already have MS, because they've already changed in compare to controls, adding further somehow differences are related to what causes MS, because these individuals have already changed their behavior because they've got a chronic disease. So that's the first statement, which might be a no-brainer for some people, but it's amazing how many studies are still published like that in the MS literature at the moment. And I suppose the second piece is trying to understand if we are going to do an interventional study, what time period in an individual's life or within a population do you need to target in order to change the course and prevent the disease from occurring? And we're trying to understand that more, looking beyond the window age 5 to 15, look more into adulthood to see if ambient UVB is associated with MS risk later in life and into adulthood. And others have shown that there does seem to be an association even into adulthood, which is exciting because if you do want to do an intervention study, then you haven't necessarily missed the boat because you've not intervened during childhood. But, I mean, the real question is how do you intervene and what with? And that's another topic in itself. MSDF We'll leave that for another day. Thank you. Dr. Tremlett Thank you very much. [transition music] Next week, we'll continue our discussion with Professor Tremlett when she'll talk about her preliminary studies on pediatric MS patients and their gut microbiomes. Until then, thank you for listening to Episode Sixty-Three of Multiple Sclerosis Discovery. This Podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Carol Cruzan Morton. Heather McDonald curated the MSDF drug database updates. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations. Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances. We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org. For Multiple Sclerosis Discovery, I'm Dan Keller. [outro music]

[intro music]   Hello, and welcome to Episode Sixteen of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m your host, Dan Keller.   This week’s podcast features an interview with Dr. Revere “Rip” Kinkel about how to improve patient outreach. But to begin, here is a brief summary of some of the latest developments on the MS Discovery Forum at msdiscovery.org.   First, researchers are questioning if cognitive MS is a distinct entity. For some patients with MS, cognitive symptoms dominate over all other symptoms. Some of the symptoms could even be described as dementia. Researchers examined a small sample of this distinct subset of patients in a recent study in Clinical Neurology and Neurosurgery and found that many had severe brain atrophy and a high lesion load. While the results suggest that cognitive MS may be a distinct disease entity, the researchers are cautious not to draw any conclusions due to the small sample size and the weight of the term “dementia”.   An experimental oral agent for the treatment of relapse-remitting MS looks promising as it progresses through clinical trials. The drug, currently called RPC1063, was shown to be both safe and effective in a sample of about 200 patients. It may even be safer than fingolimod, which is currently the only oral drug FDA approved for the treatment of MS.   For women with multiple sclerosis, pregnancy is especially tricky. In a previous news synthesis, science writer and immunologist, Griselda Zuccarino-Catania, looked at many challenges for women with MS who are trying to get pregnant. But postpartum can be a tumultuous time for MS patients as well, since the risk for relapse increases after delivery. In this part of her series on pregnancy and MS, Zuccarino-Catania explores the current research on postpartum relapse risks, breast feeding, and disease-modifying therapies.   [transition music]   Now to the interview. Dr. Revere—or “Rip”—Kinkel is the director of the multiple sclerosis program at the University of California, San Diego. He is also the chief medical officer for an initiative managed by the Accelerated Cure Project, our parent organization, to establish an MS patient-powered research network. He sat down with me at the joint ACTRIMS-ECTRIMS meeting in Boston earlier this year to discuss how to improve patient outreach.   Interviewer – Dan Keller Welcome, Dr. Kinkel. You are now interested in new models of care. What do these entail, and why do we need them?   Interviewee – Revere Kinkel Well the traditional model is, of course, the patients coming into a clinic setting at a variable interval and having a diminishing amount of time to spend with a physician or any other kind of provider that they are seeing. Going forward in the future with fewer neurologists, fewer MS specialists available, we need to find ways to reach larger populations of patients. Whether that be through Internet portals, whether that be through outreach, through community clinics where we travel or whether it be through telemedicine or a combination of those things. So we are particularly interested in developing tools and models that allow us to reach patients in this way.   MSDF What are some of the ways that you reach them: go out in the community or how do you specifically reach people who would not typically be contacted?   Dr. Kinkel Currently we are doing a number of things. The first thing we have done is we have developed a virtual MS center online called HealthCareJourney.com which allows patients anywhere to sign up, ask questions relevant to their disease and the problems that they have and get answers. Both the questions and the answers are posted online for the entire community to see. We are also trying to find ways, particularly in California; this is true around the entire country, but particularly in California, to outreach to communities. What we have noticed with the transition with the Affordable Care Act is that a significant number of patients have been switched over to Medicaid programs. In our case we call it Medi-Cal in California. Many of these patients have been away from doctors for many years, off drugs for many years. They are not aware of services that are available to them. Many of them don't speak English as a primary language. We recognize the need to go out to the communities, have community outreach programs to reach these individuals, to do mini consults, tell them what kind of services are available, try to connect them to those services and then get them to come to our centers periodically and work with their local physicians.   MSDF Do they typically respond well to this, or are they at all wary of what you are doing?   Dr. Kinkel Well we haven't started doing it on a large scale basis. This is actually in the planning stages for next year. Interestingly we have kind of noticed this over time with drug company sponsored programs. So many of us will do these education programs for patients where we will go out and meet with a large group and we are always intrigued by the interactions we have one-on-one with the patients afterwards. That is when we really find out the issues they have and they start to hear about the things that are available for them and their eyebrows go up, they are interested, and you hear from them again because you can help them. That kind of setting has shown us that this kind of reaching out to communities helps. What I am talking about is going a step further; which is reaching out through community health centers, through other advocacy groups to find even less advantaged patients that might not have been even going to these kinds of programs and helping them, but also, including them in the process. Right now we have an understanding of MS that is based on a population that primarily goes to tertiary care centers, which is highly over-represented by Caucasian well-educated upper middle class individuals. We have far less of a knowledge of the needs and requirements of the less fortunate.   MSDF Have you heard it all or can you discern anything from reaching out to these people and what they tell you that is either surprising or new?   Dr. Kinkel I am totally amazed at kind of the lack of information they have. Just from basic MS-101. So you have to start there. Many of these individuals have kind of higher needs. When you have the needs of just putting food on the table and paying the rent and trying to make sure their children are safe, MS takes a back seat. Often in many of these families you see the effects of MS on the children, much as we see in all populations, but it is particularly acute on those individuals with less resources available to them. So there is a greater community need for support for these individuals both in terms of real services as well as in terms of education.   MSDF What are you getting out of PCORI? First of all can you define what it is, and what sort of resources they can provide you?   Dr. Kinkel PCORI stands for the Patient Centered Outcomes Research Institute, and the Accelerated Cure Project has a grant to develop a 20,000 patient centered research network. I am the chief medical officer for the PCORI Initiative. This will allow us to reach a large population of patients, but the challenge, much as I said a second ago, is reaching those individuals that might not even use the Internet or the web that often. So we need to find ways to not only include the traditional MS patients we see in many of the tertiary centers but also to reach out to these communities. What we intend to do with this reaching out is to get patients involved in the PCORI Initiative as one of the main things that we do when we reach out to the community. That will allow them a forum for describing their experience and potentially getting further resources available to them.    MSDF If they are not presenting to healthcare facilities, how do you reach them? Do you go to schools and get parents of kids or churches, or where do you get the word out?   Dr. Kinkel One of the advantages that we have now when the law of the land is that everybody has healthcare insurance; is that we can actually track people. It is interesting. What happens in many communities is the physicians don't accept Medicaid for instance, some don't even accept Medicare. But what they do is they will accept this when patients are acutely admitted. The scenario that we hear over and over again is these patients go to a healthcare facility when there is some kind of an acute decline in function. They get taken care of. They have a diagnosis code of 340 for MS attached to them, but then they are discharged with no followup plans. They are actually not seen again until there is another acute decline in function. Well, we can identify them as soon as they are identified as a number 340. Once that is done, then we can reach them for these community outreach initiatives.   MSDF Is this purely for diagnosis and treatment or can you do this for research? Do you get information from this?   Dr. Kinkel What we do is we outreach to patients and provide education. We do not initiate a patient physician relationship without their approval. So you reach out to those individuals. There is no problem with that. They have to make the step of following through and initiating that kind of an interaction. They also have to make the step of deciding that they are willing to participate in something like the PCORI Initiative. All we can try to do is be as persuasive as we can and educate them about the benefits to both them as well as the greater society.    MSDF Do you find that there are people who don't even recognize a symptom? They just think their arm is numb because it must have been something they did at work and pass it off?   Dr. Kinkel Oh yeah. It is an interesting phenomenon especially when things have been going on for a long time. If an individual is born blind, they don't see being blind a problem. If for the greater part of their life they have noticed that they have numbness in their feet, sometimes they don't mention it, because they don't consider it a problem. We always find that when we are seeing patients for the first time, they will describe these vague neurological symptoms that go back for many years.    MSDF Tell me about the OPT-UP project?   Dr. Kinkel So the OPT-UP project is just a part of the normal evolution of the Accelerated Cure Project. The Accelerated Cure Project was developed to have a repository of well characterized patients with their biological samples for researchers around the country. We recognize that there were issues with the repository. We didn't have good longitudinal samples; we couldn't guarantee that we had samples on patients before and after they went on drugs so we could look at biological responses. So the OPT-UP study was to address that as well as the need to begin to create an environment where we were combining clinical and research activities to get more patients involved in research activities. By that I mean we know very little about long-term outcomes in MS. Part of this is because there is no coordinated manner to collect data longitudinally that is agreed upon between all of the clinicians that are caring for these patients. So we wanted to kind of operationalize that process so that we could follow these long-term outcomes and collect them. By doing so, we can answer a lot of questions that we have. For instance, in the near term with the OPT-UP study, since the only requirement for the study is that a person be initiating a drug, whether it be for the first time or for the tenth time, they are just initiating drug. One of the things that we will learn is; what are the reasons why people start drugs, what are the reasons why they stop drugs, what are the reasons why doctors are putting them on this drug or that drug. We know very little about that. What we really do know still is that a tremendous number of patients at least 50% discontinue a drug within two years of starting it. If we don't first know exactly why this behavior exists, it is hard to keep patients on therapies for a longer period of time, and to see which therapies are going to be most beneficial.    MSDF Will this go on indefinitely?   Dr. Kinkel It is a long-term study. The duration of a study is always dependent upon a number of factors; funding, interest, but yes we are building in a number of mechanisms that allow us to follow patients for a very long time in the study. Probably the key to this is a dedicated nurse research coordinator at each site that will be responsible for entering and following patients over a period of time. And when sites exceed a certain number of patients then they hire another one, because what we have discovered in the past from the many research studies that we do is there are competing interests. Whenever we try to continue to follow people for a long time, other interests win out. There is no one there to kind of encourage the patient to continue their participation. The studies that have been more successful – a long-term study like the Nurses' Health Study – they are able to do that primarily because they put the resources into ensuring that, that experience is meaningful for the patients and that they will want to continue to contribute that data.   MSDF Will this initiative also collect general health data knowing about comorbidities and be able to correlate those with the course of the disease?   Dr. Kinkel Yes absolutely. It is one of the main things that we want to do. In fact, one of the reasons why pretty much the only inclusion criteria is, that a person be starting a drug. Most Phase III studies exclude people when they have other health conditions. This is why there is so little external validity to these studies. The way we gain that validity is to encourage those patients who do not normally contribute to clinical research to participate in the study, either because they don’t want to, they can't get to the site, or because they are excluded by the exclusion criteria.   MSDF On these topics, is there anything important to add?   Dr. Kinkel I think the most important thing to add is that we are entering into an era…we are already in an era in which technology is rapidly transforming how we reach patients, and we need to kind of embrace it. I see that many of my colleagues are reluctant to. I see it in their unwillingness to embrace electronic medical records for instance. They see it as a burden.  And it is true; there is some burdensome aspects to it. I believe, however, in a world in which they have less time to spend individually with their patients in a clinic setting, in that kind of a world, they need to find other mechanisms to reach and meet those needs of their patients. One of the ways to do that is through these kinds of technologies. Using the website. I encourage them to send their patients to the healthcarejourney.com website for instance to get general information about MS so that they can reduce the burden on their own centers and their own staff with patients calling in with questions every other second.   MSDF Very good. I appreciate it.   Dr. Kinkel Thank you.   [transition music]   Thank you for listening to Episode Sixteen of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Robert Finn. Msdiscovery.org is part of the non-profit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is vice president of scientific operations.    Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances.   We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org.    [outro music]    

Dr. Ashwin N. Ananthakrishnan discusses his manuscript "Association Between Depressive Symptoms and Incidence of Crohn's Disease and Ulcerative Colitis: Results From the Nurses' Health Study."

Editor-in-chief Shawn Kennedy and clinical editor Christine Moffa present the highlights of the April issue of the American Journal of Nursing, which features two CE articles: one is original research, examining data from the Nurses Health Study analyzing trends in remission or progression of urinary incontinence among black, white and Hispanic women, and another on evidence-based feeding strategies for people with dementia. Other articles include a feature describing an online tool to develop care plans for cancer survivors and another focusing on sexual concerns after breast cancer; an article explaining why and how to use social media sites; another article in our Letters from Afghanistan series; an interview with a nurse who helped her hospital “go green”. And there's News, Drug Watch, and more.

Editor-in-chief Shawn Kennedy and clinical editor Christine Moffa present the highlights of the April issue of the American Journal of Nursing, which features two CE articles: one is original research, examining data from the Nurses Health Study analyzing trends in remission or progression of urinary incontinence among black, white and Hispanic women, and another on evidence-based feeding strategies for people with dementia. Other articles include a feature describing an online tool to develop care plans for cancer survivors and another focusing on sexual concerns after breast cancer; an article explaining why and how to use social media sites; another article in our Letters from Afghanistan series; an interview with a nurse who helped her hospital “go green”. And there’s News, Drug Watch, and more.