Penny George Institute for Health and Healing

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Abstract Background: People who self-harm are at high risk for future suicide and often suffer considerable emotional distress. Depression is common among people who self-harm and may be an underlying driver of self-harm behaviour. Self-harm is often repeated, and risk of repetition is highest immediately after an act of self-harm. Readily accessible brief talking therapies show promise in helping people who self-harm, but further evaluation of these approaches is needed. A brief talking therapy intervention for depression and self-harm, has been designed for use in a community setting. This mixed methods feasibility study with repeated measures will examine the feasibility and acceptability of the Community Outpatient Psychological Engagement Service for Self-Harm (COPESS) for people with self-harm and depression in the community compared to routine care. Methods: We will recruit 60 participants with a history of self-harm within the last six months, who are also currently depressed, to take part in a feasibility single blind randomised controlled trial (RCT). We will randomise participants 1:1 to receive COPESS plus treatment as usual (TAU) or TAU alone. Recruitment will take place via GP practices and self-referral. Assessment of feasibility and acceptability will be assessed via quantitative and qualitative methods including measures of recruitment and retention to the trial, participants’ experience of therapy, completion / completeness of outcome measures at relevant time-points and completion of a service use questionnaire. Discussion: The results will indicate whether it is feasible to conduct a definitive trial to determine whether COPESS is a clinically, cost-effective intervention for those who self-harm in the community. The qualitative and quantitative data will help identify the potential strengths or challenges of brief community-based interventions for self-harm. Trial registration: NCT04191122 registered 9th December 2019, https://clinicaltrials.gov/ct2/show/NCT04191122?term=NCT04191122&draw=2&rank=1

Introduction: The short-chain fatty acids (SCFA) acetic acid, propionic acid, and butyric acid are microbial-produced metabolites that can influence host physiology through regulation of hepatic cholesterol metabolism. These biologically relevant gut metabolites may play a role in the hypocholesterolemic effects of select dietary components. The objective of this exploratory study was to determine the effects of diets that differ only in fatty acid composition on fecal SCFA levels and to assess their correlations with circulating lipids, lipoproteins, and apolipoproteins. Hypothesis: We assessed the hypothesis that dietary fat quality will differentially affect fecal SCFA and there will be significant associations between fecal SCFA levels and those of circulating total cholesterol, low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), and apolipoprotein (apo) B. Methods: In a double-blind, randomized, three period crossover, controlled feeding clinical trial, participants with ≥2 metabolic syndrome criteria (n=20) were provided with a weight maintenance, controlled feeding base diet plus conventional canola oil, high-oleic acid canola oil (HOCO), or a control oil (control diet formulated to represent a Western diet fatty acid profile) for 6 weeks followed by washout periods of ≥4 weeks. The macronutrient profiles of the diets were: canola diet [17.5% monounsaturated fatty acid (MUFA), 9.2% polyunsaturated fatty acid (PUFA), 6.6% saturated fatty acid (SFA)], HOCO diet (19.1% MUFA, 7.0% PUFA, 6.4% SFA), and control diet (10.5% MUFA, 10.0% PUFA, 12.3% SFA). Fecal and blood samples were collected at study enrollment and at the end of each diet. Results: After 6 weeks, a trend toward a treatment effect on endpoint fecal propionic acid was observed ( P =0.09), with a trend toward a higher concentration following the control compared to the canola diet ( P =0.09). Acetic acid was increased from baseline following the control diet ( P =0.04). After the control diet only, fecal levels of propionic acid were positively correlated with blood levels of LDL-C, non-HDL-C, and apo B (r=0.52 to 0.64, P =0.003 to 0.02), with a trend for total cholesterol (r=0.39, P =0.10), and acetic acid was positively correlated with LDL-C and apo B levels (r=0.48 to 0.49, P =0.03 to 0.04), with a trend for non-HDL-C (r=0.44, P =0.06). No significant correlations between fecal SCFA and lipids and lipoproteins were observed after the two canola oil-based diets. Conclusions: In conclusion, these data suggest that the adverse effects of a contemporary Western diet fatty acid profile on circulating lipid and lipoprotein parameters compared to diets higher in unsaturated fat and lower in SFA may be mediated by gut-derived SCFA.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

ObjectiveTo examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital.DesignRetrospective electronic health record review and structured qualitative interviews.SettingA 630-bed tertiary care hospital with an IM service available to inpatients.ParticipantsIM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services.ResultsIn the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients.ConclusionsConventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings.

When a patient with symptoms presents to a physician or other healthcare professional, the skillful practitioner notices not only where the patient is compromised but also how the patient is healthy. From ancient times through the present, this way of seeing individual patients as whole beings, as having both strengths and challenges, has been the hallmark of professional practice. And now is the time to advance patient care through a focus on whole systems approaches.

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Research MethodologyComparison of Integrative Health Therapies as Related to Pain and the Influence of Sleeping Patients as Missing DataRachael Rivard, Kristen Haven, Jill Johnson, and Jeff DusekRachael RivardSearch for more papers by this author, Kristen HavenSearch for more papers by this author, Jill JohnsonSearch for more papers by this author, and Jeff DusekSearch for more papers by this authorPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5361.abstractAboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Comparison of Integrative Health Therapies as Related to Pain and the Influence of Sleeping Patients as Missing Data." The Journal of Alternative and Complementary Medicine, 20(5), pp. A134–A135FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Rachael Rivard, Kristen Haven, Jill Johnson, and Jeff Dusek.Comparison of Integrative Health Therapies as Related to Pain and the Influence of Sleeping Patients as Missing Data.The Journal of Alternative and Complementary Medicine.May 2014.A134-A135.http://doi.org/10.1089/acm.2014.5361.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Oral Abstract Session 07: Integrative Medicine in Clinical CareEffects of Integrative Medicine on Pain and Anxiety Among Oncology InpatientsJill Johnson, Michael Finch, Rachael Rivard, and Jeffery DusekJill JohnsonSearch for more papers by this author, Michael FinchSearch for more papers by this author, Rachael RivardSearch for more papers by this author, and Jeffery DusekSearch for more papers by this authorPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5027.abstractAboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Effects of Integrative Medicine on Pain and Anxiety Among Oncology Inpatients." The Journal of Alternative and Complementary Medicine, 20(5), p. A12FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Jill Johnson, Michael Finch, Rachael Rivard, and Jeffery Dusek.Effects of Integrative Medicine on Pain and Anxiety Among Oncology Inpatients.The Journal of Alternative and Complementary Medicine.May 2014.A12-A12.http://doi.org/10.1089/acm.2014.5027.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download