Next Issue
Previous Issue

Table of Contents

Healthcare, Volume 5, Issue 1 (March 2017)

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Readerexternal link to open them.
View options order results:
result details:
Displaying articles 1-17
Export citation of selected articles as:

Editorial

Jump to: Research, Review, Other

Open AccessEditorial Acknowledgement to Reviewers of Healthcare in 2016
Healthcare 2017, 5(1), 3; doi:10.3390/healthcare5010003
Received: 10 January 2017 / Revised: 10 January 2017 / Accepted: 10 January 2017 / Published: 10 January 2017
PDF Full-text (155 KB) | HTML Full-text | XML Full-text

Research

Jump to: Editorial, Review, Other

Open AccessArticle A Model of Health for Family Caregivers of Elders
Healthcare 2017, 5(1), 1; doi:10.3390/healthcare5010001
Received: 11 August 2016 / Revised: 6 December 2016 / Accepted: 14 December 2016 / Published: 22 December 2016
PDF Full-text (453 KB) | HTML Full-text | XML Full-text
Abstract
Family members who provide care to their loved ones experience changes in their own health. The caregiver health model (CGHM) is a new model that identifies health holistically and identifies four determinant(s) that contribute to the health status of the family caregiver. The
[...] Read more.
Family members who provide care to their loved ones experience changes in their own health. The caregiver health model (CGHM) is a new model that identifies health holistically and identifies four determinant(s) that contribute to the health status of the family caregiver. The purpose is to introduce the CGHM: Hypothesis 1: the determinants of health in the CGHM contribute to the health of the Caregiver, Hypothesis 2: the determinants of health contribute to changes in the caregivers’ health at 8 and 16 weeks, and Hypothesis 3: a change in health occurs from baseline to 8 and 16 weeks. Methods: A descriptive, longitudinal design used three data collection points and five survey instruments. Community recruitment (N = 90) occurred through word of mouth and newspapers. Inclusion criteria consisted of being a family caregiver, living in a rural residence, and providing care to elders with necessary activities of daily living (ADLs) and/or instrumental ADLs (IADLs). Following a participant generated phone call to provide consent, caregivers received an initial study packet, additional packets were sent upon return of the previous packet. Analysis for the three hypotheses included multiple backwards stepwise linear regression, generalized estimating equations (GEE), and analysis of variance (ANOVA) α = 0.05. Results: A significant decrease in mental (p < 0.01) but not physical health at 8 weeks (p = 0.38) and 16 weeks (p = 0.29) occurred over time. Two determinants displayed significant (p < 0.05 or less) changes in mental and/or physical health at one or more time points. Study limitations include caregiver entry at varying times and self-report of elder nursing needs and medical conditions. Conclusions: Findings support two of the four determinants contributing to caregiver health. Full article
Figures

Figure 1

Open AccessArticle Impact of Menthol Smoking on Nicotine Dependence for Diverse Racial/Ethnic Groups of Daily Smokers
Healthcare 2017, 5(1), 2; doi:10.3390/healthcare5010002
Received: 11 November 2016 / Revised: 19 December 2016 / Accepted: 4 January 2017 / Published: 11 January 2017
PDF Full-text (211 KB) | HTML Full-text | XML Full-text
Abstract
Introduction: The aims of this study were to evaluate whether menthol smoking and race/ethnicity are associated with nicotine dependence in daily smokers. Methods: The study used two subsamples of U.S. daily smokers who responded to the 2010–2011 Tobacco Use Supplement to
[...] Read more.
Introduction: The aims of this study were to evaluate whether menthol smoking and race/ethnicity are associated with nicotine dependence in daily smokers. Methods: The study used two subsamples of U.S. daily smokers who responded to the 2010–2011 Tobacco Use Supplement to the Current Population Survey. The larger subsample consisted of 18,849 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (HISP) smokers. The smaller subsample consisted of 1112 non-Hispanic American Indian/Alaska Native (AIAN), non-Hispanic Asian (ASIAN), non-Hispanic Hawaiian/Pacific Islander (HPI), and non-Hispanic Multiracial (MULT) smokers. Results: For larger (smaller) groups the rates were 45% (33%) for heavy smoking (16+ cig/day), 59% (51%) for smoking within 30 min of awakening (Sw30), and 14% (14%) for night-smoking. Overall, the highest prevalence of menthol smoking corresponded to NHB and HPI (≥65%), followed by MULT and HISP (31%–37%), and then by AIAN, NHW, and ASIAN (22%–27%) smokers. For larger racial/ethnic groups, menthol smoking was negatively associated with heavy smoking, not associated with Sw30, and positively associated with night-smoking. For smaller groups, menthol smoking was not associated with any measure, but the rates of heavy smoking, Sw30, and night-smoking varied across the groups. Conclusions: The diverse associations between menthol smoking and nicotine dependence maybe due to distinction among the nicotine dependence measures, i.e., individually, each measure assesses a specific smoking behavior. Menthol smoking may be associated with promoting smoking behaviors. Full article
Open AccessArticle Brazilian Specialists’ Perspectives on the Patient Referral Process
Healthcare 2017, 5(1), 4; doi:10.3390/healthcare5010004
Received: 20 September 2016 / Revised: 19 January 2017 / Accepted: 21 January 2017 / Published: 29 January 2017
PDF Full-text (201 KB) | HTML Full-text | XML Full-text
Abstract
Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary
[...] Read more.
Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists’ perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients’ inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them. Full article
Open AccessArticle Reducing Low Birth Weight among African Americans in the Midwest: A Look at How Faith-Based Organizations Are Poised to Inform and Influence Health Communication on the Developmental Origins of Health and Disease (DOHaD)
Healthcare 2017, 5(1), 6; doi:10.3390/healthcare5010006
Received: 1 October 2016 / Revised: 17 January 2017 / Accepted: 24 January 2017 / Published: 4 February 2017
PDF Full-text (201 KB) | HTML Full-text | XML Full-text
Abstract
Low birth weight (LBW) rates remain the highest among African Americans despite public health efforts to address these disparities; with some of the highest racial disparities in the Midwest (Kansas). The Developmental Origins of Health and Disease (DOHaD) perspective offers an explanation for
[...] Read more.
Low birth weight (LBW) rates remain the highest among African Americans despite public health efforts to address these disparities; with some of the highest racial disparities in the Midwest (Kansas). The Developmental Origins of Health and Disease (DOHaD) perspective offers an explanation for how LBW contributes to racial health disparities among African Americans and informs a community directed health communication framework for creating sustainable programs to address these disparities. Trusted community organizations such as faith-based organizations are well situated to explain health communication gaps that may occur over the life course. These entities are underutilized in core health promotion programming targeting underserved populations and can prove essential for addressing developmental origins of LBW among African Americans. Extrapolating from focus group data collected from African American church populations as part of a social marketing health promotion project on cancer prevention, we theoretically consider how a similar communication framework and approach may apply to address LBW disparities. Stratified focus groups (n = 9) were used to discover emergent themes about disease prevention, and subsequently applied to explore how faith-based organizations (FBOs) inform strategic health care (media) advocacy and health promotion that potentially apply to address LBW among African Americans. We argue that FBOs are poised to meet health promotion and health communication needs among African American women who face social barriers in health. Full article
Open AccessArticle Socio-Demographic Determinants of Diet Quality in Australian Adults Using the Validated Healthy Eating Index for Australian Adults (HEIFA-2013)
Healthcare 2017, 5(1), 7; doi:10.3390/healthcare5010007
Received: 27 October 2016 / Revised: 20 January 2017 / Accepted: 23 January 2017 / Published: 4 February 2017
Cited by 2 | PDF Full-text (232 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011–2012 National Nutrition
[...] Read more.
Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011–2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended. Full article
(This article belongs to the Special Issue Diet Quality)
Open AccessArticle Preventive Healthcare: A Neural Network Analysis of Behavioral Habits and Chronic Diseases
Healthcare 2017, 5(1), 8; doi:10.3390/healthcare5010008
Received: 30 November 2016 / Revised: 18 January 2017 / Accepted: 19 January 2017 / Published: 6 February 2017
PDF Full-text (908 KB) | HTML Full-text | XML Full-text
Abstract
The research aims to explore the association between behavioral habits and chronic diseases, and to identify a portfolio of risk factors for preventive healthcare. The data is taken from the Behavioral Risk Factor Surveillance System (BRFSS) database of the Centers for Disease Control
[...] Read more.
The research aims to explore the association between behavioral habits and chronic diseases, and to identify a portfolio of risk factors for preventive healthcare. The data is taken from the Behavioral Risk Factor Surveillance System (BRFSS) database of the Centers for Disease Control and Prevention, for the year 2012. Using SPSS Modeler, we deploy neural networks to identify strong positive and negative associations between certain chronic diseases and behavioral habits. The data for 475,687 records from BRFS database included behavioral habit variables of consumption of soda and fruits/vegetables, alcohol, smoking, weekly working hours, and exercise; chronic disease variables of heart attack, stroke, asthma, and diabetes; and demographic variables of marital status, income, and age. Our findings indicate that with chronic conditions, behavioral habits of physical activity and fruit and vegetable consumption are negatively associated; soda, alcohol, and smoking are positively associated; and income and age are positively associated. We contribute to individual and national preventive healthcare by offering a portfolio of significant behavioral risk factors that enable individuals to make lifestyle changes and governments to frame campaigns and policies countering chronic conditions and promoting public health. Full article
Figures

Figure 1

Open AccessArticle WearSense: Detecting Autism Stereotypic Behaviors through Smartwatches
Healthcare 2017, 5(1), 11; doi:10.3390/healthcare5010011
Received: 14 December 2016 / Revised: 16 February 2017 / Accepted: 21 February 2017 / Published: 28 February 2017
Cited by 2 | PDF Full-text (2179 KB) | HTML Full-text | XML Full-text
Abstract
Autism is a complex developmental disorder that affects approximately 1 in 68 children (according to the recent survey conducted by the Centers for Disease Control and Prevention—CDC) in the U.S., and has become the fastest growing category of special education. Each student with
[...] Read more.
Autism is a complex developmental disorder that affects approximately 1 in 68 children (according to the recent survey conducted by the Centers for Disease Control and Prevention—CDC) in the U.S., and has become the fastest growing category of special education. Each student with autism comes with her or his own unique needs and an array of behaviors and habits that can be severe and which interfere with everyday tasks. Autism is associated with intellectual disability, impairments in social skills, and physical health issues such as sleep and abdominal disturbances. We have designed an Internet-of-Things (IoT) framework named WearSense that leverages the sensing capabilities of modern smartwatches to detect stereotypic behaviors in children with autism. In this work, we present a study that used the inbuilt accelerometer of a smartwatch to detect three behaviors, including hand flapping, painting, and sibbing that are commonly observed in children with autism. In this feasibility study, we recruited 14 subjects to record the accelerometer data from the smartwatch worn on the wrist. The processing part extracts 34 different features in each dimension of the three-axis accelerometer, resulting in 102 features. Using and comparing various classification techniques revealed that an ensemble of 40 decision trees has the best accuracy of around 94.6%. This accuracy shows the quality of the data collected from the smartwatch and feature extraction methods used in this study. The recognition of these behaviors by using a smartwatch would be helpful in monitoring individuals with autistic behaviors, since the smartwatch can send the data to the cloud for comprehensive analysis and also to help parents, caregivers, and clinicians make informed decisions. Full article
Figures

Figure 1

Open AccessArticle Minerals and Trace Elements Intakes and Food Consumption Patterns of Young Children Living in Rural Areas of Tibet Autonomous Region, P.R. China: A Cross-Sectional Survey
Healthcare 2017, 5(1), 12; doi:10.3390/healthcare5010012
Received: 15 September 2016 / Revised: 4 January 2017 / Accepted: 5 January 2017 / Published: 1 March 2017
Cited by 1 | PDF Full-text (300 KB) | HTML Full-text | XML Full-text
Abstract
Background and objectives: Several studies revealed clinical signs of stunting and rickets among rural populations of Tibet Autonomous Region (T.A.R.), and especially amid children. Further, these populations are affected by a bone disease named Kashin-Beck disease (KBD). However, little is known about the
[...] Read more.
Background and objectives: Several studies revealed clinical signs of stunting and rickets among rural populations of Tibet Autonomous Region (T.A.R.), and especially amid children. Further, these populations are affected by a bone disease named Kashin-Beck disease (KBD). However, little is known about the dietary status of this population. This survey aimed to assess the usual intakes of young Tibetan children living in rural areas around Lhasa for energy, water, and ten minerals and trace elements (Na, K, Ca, P, Mg, Fe, Zn, Cu, Mn, and Se) involved in bone metabolism. Design: A cross-sectional survey was designed. Totally, 250 pre-school children aged 3–5 years living in rural areas were enrolled. The 24-h food recall method was used to collect the intakes for two days, during two different seasons (September 2012 and April 2013). Because Tibetan foods are mainly derived from local agriculture and artisanal production, a combination of food composition tables was compiled, including specific and local food composition data. Results: The Chinese dietary recommended intakes are not met for most of the elements investigated. Intake of sodium is much too high, while usual intakes are too low for K, Ca, Zn, Cu, and Se. Bioavailability of Ca, Fe, and Zn may be of concern due to the high phytic acid content in the diet. Conclusion: These nutrient imbalances may impact growth and bone metabolism of young Tibetan children. The advantages of the implementation of food diversification programs are discussed as well as the relevance of supplements distribution. Full article
(This article belongs to the Special Issue Diet Quality)
Open AccessArticle Knowledge, Attitude and Behaviours towards Recommended Vaccinations among Healthcare Workers
Healthcare 2017, 5(1), 13; doi:10.3390/healthcare5010013
Received: 31 January 2017 / Revised: 27 February 2017 / Accepted: 1 March 2017 / Published: 7 March 2017
PDF Full-text (217 KB) | HTML Full-text | XML Full-text
Abstract
Healthcare workers (HCWs) are an important group of professionals exposed to biological risk during their work activities. So, the aim of this study is to perform a survey on the knowledge, attitude and behaviour of Italian HCWs towards the vaccinations recommended by the
[...] Read more.
Healthcare workers (HCWs) are an important group of professionals exposed to biological risk during their work activities. So, the aim of this study is to perform a survey on the knowledge, attitude and behaviour of Italian HCWs towards the vaccinations recommended by the Ministry of Health. A cross-sectional study was carried out during the period September 2014–August 2015 in the Lazio region. The study was conducted by recruiting HCWs and biomedical students. The sample was comprised of 571 responders, of whom 12.4% were physicians, 18.9% were nurses, 34.3% were other HCW, and 34.3% were biomedical students (medical and nurses students). Hepatitis B virus (HBV) is perceived as a risk for personal health by 457 (80%) participants; TB is also worrying (434; 76%). Moreover, HBV (70.9%) and tuberculosis (TB) (79.2%) are perceived as a risk for health, while influenza is not considered so by most participants (46.2%). There is an underestimation of the role of influenza, perceived as a risk for 137 respondents (24%). The vaccination rate among these HCWs is highest for Hepatitis B virus (HBV) (82%), and lowest for influenza (28.5%) and varicella (40.3%). The vast majority of responders are in favour of HBV (77.8%) and TB (64.8%) vaccines. For other vaccinations there is less interest (between 33% and 40% for measles, mumps, rubella, pertussis and influenza). This study shows that knowledge of recommended occupational vaccinations is insufficient in HCWs, with few exceptions represented by HBV and TB. There is a need for novel approaches in this field, with the aim of enhancing vaccine coverage among HCW. Full article
(This article belongs to the Special Issue Occupational Health Issues in the New Millennium)
Open AccessArticle Mobile Phonocardiogram Diagnosis in Newborns Using Support Vector Machine
Healthcare 2017, 5(1), 16; doi:10.3390/healthcare5010016
Received: 15 December 2016 / Revised: 12 February 2017 / Accepted: 15 March 2017 / Published: 18 March 2017
PDF Full-text (1781 KB) | HTML Full-text | XML Full-text
Abstract
Phonocardiogram (PCG) monitoring on newborns is one of the most important and challenging tasks in the heart assessment in the early ages of life. In this paper, we present a novel approach for cardiac monitoring applied in PCG data. This basic system coupled
[...] Read more.
Phonocardiogram (PCG) monitoring on newborns is one of the most important and challenging tasks in the heart assessment in the early ages of life. In this paper, we present a novel approach for cardiac monitoring applied in PCG data. This basic system coupled with denoising, segmentation, cardiac cycle selection and classification of heart sound can be used widely for a large number of the data. This paper describes the problems and additional advantages of the PCG method including the possibility of recording heart sound at home, removing unwanted noises and data reduction on a mobile device, and an intelligent system to diagnose heart diseases on the cloud server. A wide range of physiological features from various analysis domains, including modeling, time/frequency domain analysis, an algorithm, etc., is proposed in order to extract features which will be considered as inputs for the classifier. In order to record the PCG data set from multiple subjects over one year, an electronic stethoscope was used for collecting data that was connected to a mobile device. In this study, we used different types of classifiers in order to distinguish between healthy and pathological heart sounds, and a comparison on the performances revealed that support vector machine (SVM) provides 92.2% accuracy and AUC = 0.98 in a time of 1.14 seconds for training, on a dataset of 116 samples. Full article
Figures

Figure 1

Review

Jump to: Editorial, Research, Other

Open AccessReview The Role of Lipid Biomarkers in Major Depression
Healthcare 2017, 5(1), 5; doi:10.3390/healthcare5010005
Received: 28 October 2016 / Revised: 20 January 2017 / Accepted: 23 January 2017 / Published: 3 February 2017
Cited by 2 | PDF Full-text (774 KB) | HTML Full-text | XML Full-text
Abstract
In the UK, the lifetime-documented prevalence of major depressive disorder (MDD) is currently 10%. Despite its increasing prevalence and devastating impact on quality of life, the pathophysiological mechanisms underpinning MDD remain to be fully elucidated. Current theories of neurobiological components remain incomplete and
[...] Read more.
In the UK, the lifetime-documented prevalence of major depressive disorder (MDD) is currently 10%. Despite its increasing prevalence and devastating impact on quality of life, the pathophysiological mechanisms underpinning MDD remain to be fully elucidated. Current theories of neurobiological components remain incomplete and protein-centric, rendering pharmacological treatment options suboptimal. In this review, we highlight the pivotal role of lipids in intra- and inter-neuronal functioning, emphasising the potential use of lipids as biomarkers for MDD. The latter has significant implications for improving our understanding of MDD at the cellular and circuit level. There is particular focus on cholesterol (high and low density lipoprotein), omega-3, and omega-6 polyunsaturated fatty acids due to established evidence in the literature of a link between atherosclerotic disease and major depression. We argue that there is significant potential scope for the use of such peripheral biomarkers in the diagnosis, stratification and treatment of MDD. Full article
(This article belongs to the Special Issue Diet Quality)
Figures

Figure 1

Open AccessReview UK Dietary Policy for the Prevention of Cardiovascular Disease
Healthcare 2017, 5(1), 9; doi:10.3390/healthcare5010009
Received: 3 November 2016 / Revised: 10 February 2017 / Accepted: 13 February 2017 / Published: 20 February 2017
PDF Full-text (923 KB) | HTML Full-text | XML Full-text
Abstract
Nutrition advice is devolved within each of the four UK countries, but share a common evidence base provided through the Scientific Advisory Committee on Nutrition (SACN). Current UK dietary recommendations to prevent cardiovascular disease (CVD) is based upon recommendations from SACN and its
[...] Read more.
Nutrition advice is devolved within each of the four UK countries, but share a common evidence base provided through the Scientific Advisory Committee on Nutrition (SACN). Current UK dietary recommendations to prevent cardiovascular disease (CVD) is based upon recommendations from SACN and its predecessor committee. Dietary advice in the UK has recently been revised in relation to intakes of free sugar and fibre. This paper highlights current UK recommendations for the prevention of CVD, in particular related to energy intake, saturated fat, free sugars, salt, fruit, vegetables, oily fish and fibre. It describes how this advice is promulgated including the refresh of the Eatwell Guide and wider action that will impact on CVD. Full article
(This article belongs to the Special Issue Nutrition and Cardiovascular Disease)
Figures

Figure 1

Open AccessReview Conceptual Foundations of Systems Biology Explaining Complex Cardiac Diseases
Healthcare 2017, 5(1), 10; doi:10.3390/healthcare5010010
Received: 12 January 2017 / Accepted: 19 February 2017 / Published: 21 February 2017
PDF Full-text (755 KB) | HTML Full-text | XML Full-text
Abstract
Systems biology is an important concept that connects molecular biology and genomics with computing science, mathematics and engineering. An endeavor is made in this paper to associate basic conceptual ideas of systems biology with clinical medicine. Complex cardiac diseases are clinical phenotypes generated
[...] Read more.
Systems biology is an important concept that connects molecular biology and genomics with computing science, mathematics and engineering. An endeavor is made in this paper to associate basic conceptual ideas of systems biology with clinical medicine. Complex cardiac diseases are clinical phenotypes generated by integration of genetic, molecular and environmental factors. Basic concepts of systems biology like network construction, modular thinking, biological constraints (downward biological direction) and emergence (upward biological direction) could be applied to clinical medicine. Especially, in the field of cardiology, these concepts can be used to explain complex clinical cardiac phenotypes like chronic heart failure and coronary artery disease. Cardiac diseases are biological complex entities which like other biological phenomena can be explained by a systems biology approach. The above powerful biological tools of systems biology can explain robustness growth and stability during disease process from modulation to phenotype. The purpose of the present review paper is to implement systems biology strategy and incorporate some conceptual issues raised by this approach into the clinical field of complex cardiac diseases. Cardiac disease process and progression can be addressed by the holistic realistic approach of systems biology in order to define in better terms earlier diagnosis and more effective therapy. Full article
Figures

Figure 1

Open AccessReview Developmental Origins of Health and Disease: A Lifecourse Approach to the Prevention of Non-Communicable Diseases
Healthcare 2017, 5(1), 14; doi:10.3390/healthcare5010014
Received: 30 November 2016 / Revised: 17 February 2017 / Accepted: 24 February 2017 / Published: 8 March 2017
Cited by 2 | PDF Full-text (413 KB) | HTML Full-text | XML Full-text
Abstract
Non-communicable diseases (NCDs), such as cardiovascular disease and osteoporosis, affect individuals in all countries worldwide. Given the very high worldwide prevalence of NCDs across a range of human pathology, it is clear that traditional approaches targeting those at most risk in older adulthood
[...] Read more.
Non-communicable diseases (NCDs), such as cardiovascular disease and osteoporosis, affect individuals in all countries worldwide. Given the very high worldwide prevalence of NCDs across a range of human pathology, it is clear that traditional approaches targeting those at most risk in older adulthood will not efficiently ameliorate this growing burden. It will thus be essential to robustly identify determinants of NCDs across the entire lifecourse and, subsequently, appropriate interventions at every stage to reduce an individual’s risk of developing these conditions. A lifecourse approach has the potential to prevent NCDs, from before conception through fetal life, infancy, childhood, adolescence, adulthood and into older age. In this paper, we describe the origins of the lifecourse concept, the importance of early life influences, for example during pregnancy, examine potential underlying mechanisms in both cell biology and behavior change, and finally describe current efforts to develop interventions that take a lifecourse approach to NCD prevention. Two principal approaches to improving women’s nutritional status are outlined: nutritional supplementation and behavior change. Full article
Figures

Figure 1

Other

Jump to: Editorial, Research, Review

Open AccessHypothesis Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin—Potential for Preventing or Slowing the Progression of Diabetic Complications
Healthcare 2017, 5(1), 15; doi:10.3390/healthcare5010015
Received: 22 November 2016 / Revised: 23 February 2017 / Accepted: 6 March 2017 / Published: 14 March 2017
PDF Full-text (339 KB) | HTML Full-text | XML Full-text
Abstract
Oxidative stress, the resulting uncoupling of endothelial nitric oxide synthase (eNOS), and loss of nitric oxide (NO) bioactivity, are key mediators of the vascular and microvascular complications of diabetes. Much of this oxidative stress arises from up-regulated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase
[...] Read more.
Oxidative stress, the resulting uncoupling of endothelial nitric oxide synthase (eNOS), and loss of nitric oxide (NO) bioactivity, are key mediators of the vascular and microvascular complications of diabetes. Much of this oxidative stress arises from up-regulated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. Phycocyanobilin (PhyCB), the light-harvesting chromophore in edible cyanobacteria such as spirulina, is a biliverdin derivative that shares the ability of free bilirubin to inhibit certain isoforms of NADPH oxidase. Epidemiological studies reveal that diabetics with relatively elevated serum bilirubin are less likely to develop coronary disease or microvascular complications; this may reflect the ability of bilirubin to ward off these complications via inhibition of NADPH oxidase. Oral PhyCB may likewise have potential in this regard, and has been shown to protect diabetic mice from glomerulosclerosis. With respect to oxidant-mediated uncoupling of eNOS, high-dose folate can help to reverse this by modulating the oxidation status of the eNOS cofactor tetrahydrobiopterin (BH4). Oxidation of BH4 yields dihydrobiopterin (BH2), which competes with BH4 for binding to eNOS and promotes its uncoupling. The reduced intracellular metabolites of folate have versatile oxidant-scavenging activity that can prevent oxidation of BH4; concurrently, these metabolites promote induction of dihydrofolate reductase, which functions to reconvert BH2 to BH4, and hence alleviate the uncoupling of eNOS. The arginine metabolite asymmetric dimethylarginine (ADMA), typically elevated in diabetics, also uncouples eNOS by competitively inhibiting binding of arginine to eNOS; this effect is exacerbated by the increased expression of arginase that accompanies diabetes. These effects can be countered via supplementation with citrulline, which efficiently enhances tissue levels of arginine. With respect to the loss of NO bioactivity that contributes to diabetic complications, high dose biotin has the potential to “pinch hit” for diminished NO by direct activation of soluble guanylate cyclase (sGC). High-dose biotin also may aid glycemic control via modulatory effects on enzyme induction in hepatocytes and pancreatic beta cells. Taurine, which suppresses diabetic complications in rodents, has the potential to reverse the inactivating impact of oxidative stress on sGC by boosting synthesis of hydrogen sulfide. Hence, it is proposed that concurrent administration of PhyCB, citrulline, taurine, and supranutritional doses of folate and biotin may have considerable potential for prevention and control of diabetic complications. Such a regimen could also be complemented with antioxidants such as lipoic acid, N-acetylcysteine, and melatonin—that boost cellular expression of antioxidant enzymes and glutathione—as well as astaxanthin, zinc, and glycine. The development of appropriate functional foods might make it feasible for patients to use complex nutraceutical regimens of the sort suggested here. Full article
Open AccessEssay Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change
Healthcare 2017, 5(1), 17; doi:10.3390/healthcare5010017
Received: 31 October 2016 / Revised: 3 March 2017 / Accepted: 14 March 2017 / Published: 20 March 2017
PDF Full-text (486 KB) | HTML Full-text | XML Full-text
Abstract
Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers.
[...] Read more.
Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health. Full article
Figures

Figure 1

Back to Top