Acetaminophen toxicity is caused when glucuronidation and sulfation become saturated after an acetaminophen overdose. The saturation of these major metabolic pathways cause the formation of excess NAPQI to be formed by CYP450-mediated N-hydroxylation (AAP, 2001). Two mechanisms can contribute to liver damage. The first of which occurs when NAPQI binds to hepatic cell macromolecules and can progress to necrotic cell death. The second mechanism is the depletion of glutathione which causes oxidative stress and subsequently liver damage and possibly death (AAP, 2001).
Acetaminophen is also one of the most widely used over-the-counter medications. Of particular concern is the ubiquitous statement about liver damage on Tylenol’s label is as follows: This product contains acetaminophen. Severe liver damage may occur if you take *more than 8 gelcaps in 24 hours, which is the maximum daily amount*with other drugs containing acetaminophen* 3 or more alcoholic drinks every day while using this product. The label does not mention that death may result as a consequence of the liver damage, nor how common overdose is associated with acetaminophen. Concurrently, the Tylenol brand has been synonymous with safety and universal applicability. This benign reputation is astounding in light of the 140,000 poisoning cases, 56,000 emergency room visits, 26,000 hospitalizations, and 150 deaths per annum (Bronstein et. al., 2006). These include accidental and intentional overdoses. The inclusion of a statement regarding the potential for death in addition to liver damage is warranted. In addition, encouraging physicians especially in primary care to address acetaminophen usage among their children and themselves would reinforce a cautionary message.
Reference:
American Academy of Pediatrics Committee on Drugs (2001) Acetaminophen toxicity in children. Pediatrics 108:1020–1024
Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. (2006) Annual Report of the American Association of Poison Control Centers National Poison Data System (NPDS). Clin Toxicol. 45, 815–917.
Schilling, A. (January 2010) Acetaminophen: Old drug, new warnings.Cleveland Clinic Journal of Medicine, 77 (1) 19-27
Saturday, April 30, 2011
Thursday, April 21, 2011
Cervical Cancer & HPV: Examining Gender-Based Vaccinations
Cervical cancer is an exemplary example of the conjunction between public health awareness, pharmaceutical influence, and women’s health. This cancer originates in the squamous cells of the cervix and is the third most common form of cancer to affect women worldwide (Kahn, 2009). This cancer has a slow progression and its precancerous condition known as dysplasia can be detected by routine Pap smear exams and is entirely treatable. Left untreated this condition can progress into cervical cancer, eventually affecting the bladder, intestines, lungs, and liver and may cause infertility and death.
The majority of cervical cancers have been determined to be caused by the Human Papilloma Virus (HPV). This virus is spread through sexual intercourse and has several risk factors including early onset of sexual activity, multiple sexual partners, and women whose mothers were prescribed diethylstilbestrol to prevent miscarriage. In June 2006, the FDA released the first vaccine to prevent cancer, Gardacil, which was specific to preventing HPV and subsequently cervical cancer (Kahn, 2009). The release of Gardacil into the market was coupled with widespread educational/marketing regarding the risks of HPV in the causation of cervical cancer (Merck, 2010). This coupling was unique not only in the revolutionary vaccine, but also in the level of awareness created about HPV by pharmaceutical promoters who lobbied for insurance companies and federal programs to routinize, subsidize, and cover the costs of vaccination in females aged 9-26 (Merck, 2010).
I understand why this vaccine targeted females as they are the only ones to suffer from cervical cancer. Yet, I was always perplexed why this vaccine was so heavily and exclusively promoted for females rather than including males as potential carriers of HPV. Recent studies have also examined the immunogenicity and safety of vaccinating males to prevent the spread of HPV and certain penile cancers associated with it (Petaja et. al., 2009). In Petaja et. al. (2009), males ages 10 to 18 years were randomized to receive HPV-16/18 AS04-adjuvanted vaccine (n = 181) or hepatitis B virus (HBV) control vaccine (n = 89) at 0, 1, and 6 months, and were followed for 7 months. Study research resulted in high antibody levels and seropositivity at the 7 month interval and concluded that the vaccine was well tolerated. The study did not specify recommendations regarding the vaccination of boys as they determined that the potential public health benefits required more data. Although I hesitate to conclude this for them, I am entirely supportive of the unilateral recommendation for vaccinating both male and females for HPV. The rationale that as predominantly carriers only, males should be excluded, is an affront to a basic public health tenant of prevention as integral and essential.
Kahn JA. (2009) HPV vaccination for the prevention of cervical intraepithelial neoplasia. New England Journal of Medicine. 16,361(3),271-278.
Merck & Co. (2010) Gardacil. Accessed April 21, 2011 from http://www.gardasil.com/
NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.NCCN. org. Accessed December 28, 2009.
Petäjä T, Keränen H, Karppa T, Kawa A, Lantela S, Siitari-Mattila M, Levänen H, Tocklin T, Godeaux O, Lehtinen M, Dubin G. (2009) Immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine in healthy boys aged 10-18 years. J Adolesc Health. 44(1):33-40.
The majority of cervical cancers have been determined to be caused by the Human Papilloma Virus (HPV). This virus is spread through sexual intercourse and has several risk factors including early onset of sexual activity, multiple sexual partners, and women whose mothers were prescribed diethylstilbestrol to prevent miscarriage. In June 2006, the FDA released the first vaccine to prevent cancer, Gardacil, which was specific to preventing HPV and subsequently cervical cancer (Kahn, 2009). The release of Gardacil into the market was coupled with widespread educational/marketing regarding the risks of HPV in the causation of cervical cancer (Merck, 2010). This coupling was unique not only in the revolutionary vaccine, but also in the level of awareness created about HPV by pharmaceutical promoters who lobbied for insurance companies and federal programs to routinize, subsidize, and cover the costs of vaccination in females aged 9-26 (Merck, 2010).
I understand why this vaccine targeted females as they are the only ones to suffer from cervical cancer. Yet, I was always perplexed why this vaccine was so heavily and exclusively promoted for females rather than including males as potential carriers of HPV. Recent studies have also examined the immunogenicity and safety of vaccinating males to prevent the spread of HPV and certain penile cancers associated with it (Petaja et. al., 2009). In Petaja et. al. (2009), males ages 10 to 18 years were randomized to receive HPV-16/18 AS04-adjuvanted vaccine (n = 181) or hepatitis B virus (HBV) control vaccine (n = 89) at 0, 1, and 6 months, and were followed for 7 months. Study research resulted in high antibody levels and seropositivity at the 7 month interval and concluded that the vaccine was well tolerated. The study did not specify recommendations regarding the vaccination of boys as they determined that the potential public health benefits required more data. Although I hesitate to conclude this for them, I am entirely supportive of the unilateral recommendation for vaccinating both male and females for HPV. The rationale that as predominantly carriers only, males should be excluded, is an affront to a basic public health tenant of prevention as integral and essential.
Kahn JA. (2009) HPV vaccination for the prevention of cervical intraepithelial neoplasia. New England Journal of Medicine. 16,361(3),271-278.
Merck & Co. (2010) Gardacil. Accessed April 21, 2011 from http://www.gardasil.com/
NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.NCCN. org. Accessed December 28, 2009.
Petäjä T, Keränen H, Karppa T, Kawa A, Lantela S, Siitari-Mattila M, Levänen H, Tocklin T, Godeaux O, Lehtinen M, Dubin G. (2009) Immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine in healthy boys aged 10-18 years. J Adolesc Health. 44(1):33-40.
Wednesday, April 20, 2011
What's on your plate? Examining genetic modification.
Having been raised in the developing world, food shortage is a critically important ethical and humanitarian issue and one that I am personally invested in. Food shortage may be less of an issue with production and more of an issue of redistribution (Pollan, 2006). The role of genetic modification and differing agricultural practices such as organic farming, aquaponics, hydroponics, etc. are all important components to this multi-faceted issue. Genetically modified organisms are not the whole answer to the complex problem of food scarcity especially when balancing high yield crops with the extensive pesticide use and expense. In light of the mass suicides in India due in part to GMO and hybrid seeds (Sengupta, 2006), one needs to examine not only the agricultural impact of such technology, but also the environmental and socio-economic issues and consequences as well. Similarly touted as agriculture’s messiah, organic farming is also considered an irresponsible venture. These alternatives may have long-term consequences that we are just beginning to understand such as potential allergencity of genetically modified foods (Goodman et. al., 2011).
Genetic modification is fundamentally a natural process. Cross-pollination, selective-breeding, genetic recombination, and hybridization all occur as natural processes in our biological system. Genetic modification differs in the rate at which these genetic recombinations occur (Weale, 2010). For example, in may take a millennia or more for a plant to develop a certain genetic trait whereas genetic modification allows for it instantaneously. This precious power is coupled with a deep responsibility that may at times be neglected in the eagerness to provide sustenance for our burgeoning world population.
References
Goodman, R.E., Tetteh, A.O. (2011) Suggested Improvements for the Allergenicity Assessment of Genetically Modified Plants Used in Foods. Current Allergy Asthma Report.
Pollan, Michael. (2006) The Omnivore’s Dilleama: A Natural History of Four Meals. Penguin Press: New York.
Sengupta, Someni, (2006) On India’s Farms, a Plague of Suicide. New York Times Accessed April 11, 2011 from http://www.nytimes.com/2006/09/19/world/asia/19india.html
Weale, Albert. (2010) Ethical arguments relevant to the use of GM crops. New Biotechnology, 27, 5.
Genetic modification is fundamentally a natural process. Cross-pollination, selective-breeding, genetic recombination, and hybridization all occur as natural processes in our biological system. Genetic modification differs in the rate at which these genetic recombinations occur (Weale, 2010). For example, in may take a millennia or more for a plant to develop a certain genetic trait whereas genetic modification allows for it instantaneously. This precious power is coupled with a deep responsibility that may at times be neglected in the eagerness to provide sustenance for our burgeoning world population.
References
Goodman, R.E., Tetteh, A.O. (2011) Suggested Improvements for the Allergenicity Assessment of Genetically Modified Plants Used in Foods. Current Allergy Asthma Report.
Pollan, Michael. (2006) The Omnivore’s Dilleama: A Natural History of Four Meals. Penguin Press: New York.
Sengupta, Someni, (2006) On India’s Farms, a Plague of Suicide. New York Times Accessed April 11, 2011 from http://www.nytimes.com/2006/09/19/world/asia/19india.html
Weale, Albert. (2010) Ethical arguments relevant to the use of GM crops. New Biotechnology, 27, 5.
Tuesday, April 12, 2011
Asthma, Allergy, and Medication Exposure in Early Childhood: A Catch-22 of Care
Living on the Island of Hawai'i has certain considerations concerning asthma as we have the highest prevalence among children in the United States.
Biological Basis
Asthma is a chronic disorder that is characterized by lung airway inflammation. This inflammation is caused and perpetuated by an inappropriate immune response, an increase in airway responsiveness, and airflow obstruction. Asthma symptoms can be mild, moderate, and severe and may include wheezing, cough, and chest tightness, among other life-threatening implications. Asthma and the closely associated allergic diseases of atopic dermatitis, allergic rhinitis, and immunoglobulin E-medicated food allergy are characterized by inflammatory T-helper cell responses of the T-helper 2 phenotype initiating and perpetuating symptoms (Devereux, 2006). Further mediators in the process include cytokines secreted by T-helper 2 cells, interleukin-4 and interleukin-13, which contribute to elevated immunoglobulin E, mast-cell regulation, and eosinophilic inflammation.
The prevalence of asthma as the world’s most common chronic disorder (Devereux, 2006) has encouraged a plethora of studies examining prenatal and postnatal exposures, environment, family history, and has resulted in an increase in awareness and subsequent diagnosis. The following discourse examines three such studies that pertain to medication exposure among infants and the association and subsequent development of asthma and allergies. Asthma predominates as a Western disease and the possible correlation between high medication usage and antibiotic usage, in particular, may depict the pitfalls of easy access and excess usage. As the following studies suggest, use of such common over-the-counter medications such as paracetamol and prescribed medications such as antibiotics in early childhood may result in a debilitating asthmatic disease requiring additional medications and/or medical attention. This seeming paradox, when adequately examined, illustrated, and exposed may result in the reduction of unintentional parentally and/or physician-induced asthma and allergies.
Research Findings
Bakkeheim et. al. (2010) examined the role of paracetamol in early infancy and the associated risk of developing childhood allergies and asthma. Paracetamol or acetaminophen is a common analgesic and antipyretic that is readily used on infants and children for fever, teething, and to alleviate general pain and discomfort. Commonly known as Tylenol, its label specifies, “Give your child Infants' Tylenol products to reduce fever and for the temporary relief of minor aches and pains associated with:Cold. Flu. Headache. Sore throat. Toothache and teething.” Its usage was examined in this prospective cohort study that included 1019 children at birth who were then reexamined at 10 years of age. Their prenatal exposure through maternal paracetamol use or postnatal exposure during the first 6 months of life were documented. Subsequent outcomes at the 10 year reexamination period included existing asthma diagnosis, a history of asthma, allergic sensitization, and/or allergic rhinitis.
Bakkeheim’s research resulted in the finding that maternal paracetomol use in the first trimester only increased the risk for allergic rhinitis with an odds ratio of 2.30 for both male and female children. The significant findings of the study related to paracetamol use until 6 months of age in girls, resulting in an increased risk of allergic sensitization (odds ratio of 2.20) and a history of asthma (odds ratio of 2.20 as well) in 10 year olds.
Further research by Risnes et. al. (2010) also examined the role of medication exposure in regards to antibiotic exposure within the first 6 months of life and the development of asthma and allergy at 6 years of age. This study included a cohort of 1401 children whose hospital records and physician records were examined to document antibiotic exposure. At 6 years of age, maternal interviews were conducted to determine whether the child had experienced an allergic reaction, if blood immunoglobulin E or a skin prink had been conducted, and the results of such testing. Those children who experienced an allergic reaction and had a positive blood or skin prick test were classified as allergy positive. Children diagnosed with asthma and who had a positive allergy test were determined to have allergic asthma.
The research findings included an increased risk of asthma (odds ratio of 1.52) among those children who had been prescribed antibiotics in infancy. The adverse effect of antibiotics use was particularly evident in children who had no family history of asthma (odds ratio 1.89). In addition, the odds ratio of a positive blood immunoglobulin E or skin prink test was 1.59 among those with early antibiotic exposure.
Sobko et. al. (2010) examined the role that neonatal sepsis and early antibiotic therapy have on bacterial colonization and immune activation in infancy and childhood. These were investigated for their implications in allergy and asthma development. This cohort study utilized a validated questionnaire by the International Study of Asthma and Allergies in Children. The three cohorts in this study that were screened examined different perinatal exposures of infection and medication exposure to antibiotics.
The research findings concluded that asthma was more prevalent after neonatal sepsis and antibiotic therapy with an adjusted odds ratio 1.63 as compared with a control group. Also documented was increased atopic eczema after neonatal sepsis (odds ratio 1.39). These findings resulted in the conclusion that neonatal sepsis is associated with an increased risk for later development of asthma and that early antibiotic exposure may be the contributing factor in this association. This study also examined the confounding bias that may occur in regards to infection and subsequent antibiotic use. Infection without the subsequent use of antibiotics did not result in the associated increase.
Public Health Application
All three studies addressed the development of childhood asthma as a result of medications (either paracetamol or antibiotics) given to children prior to 6 months of age. Collectively, they suggest that paracetamol and antibiotic usage may contribute to asthma and allergies. The public health application should pertain to preventing exposure to these medications during the 6 month infancy time-period and curbing exposure throughout early childhood. While public education efforts regarding the use of these medications in infancy is essential to curbing usage and limiting exposure, the particulars of paracetamol and antibiotics usage are unique in the way that these medications are distributed and can possibly be managed more effectively.
For example, in the use of paracetamol, the Tylenol Concentrated Infant Drops’ label specifies that its use for children under the age of 2 should be done with a doctor’s consultation. While this labeling may be intended to provide a caregiver with encouragement in contacting a child’s physician when a child is ill, this may not always occur. Therefore, specific dosing and age parameters are more efficient and useful guidelines. The label guidelines should specify that use in children less than 6 months of age has been associated with the development of asthma and allergy. Albeit this association was gender specific (Bakkenheim et. al., 2010), such considerations would need to be further researched prior to possibly ever attaching a gender-specific label to medication. In the event that a physician is contacted regarding use, the physician should adequately inform and encourage proper and limited usage.
Similar to paracetamol in that there are avenues to curbing usage, antibiotics have an additional barrier to usage, the physicians themselves. The distribution of prescriptions for antibiotic medications are limited to physicians and in some states, physicians’ assistants and registered nurses. Regardless of the persistence of parents/ caregivers, physician should address the issue of antibiotic over-prescription, especially among infants who may suffer the additional consequences of asthma and allergies. Patient awareness and education is a key contributing factor to reducing parental demand for antibiotics, but ultimately, it is a physician’s determination whether or not to prescribe antibiotics and to determine at what age they believe it is beneficial or detrimental to the current and future health status of their patients. Further physician education and awareness may also be a key component in reducing usage of antibiotics among infants.
References
Bakkehaim, E. , Mowincckel, P., Carlsen, K. H., Haland, G., Carlsen, K. (2010). Paracetamol in early infancy: the risk of childhood allergy and asthma. Acta Paediatricia, 100, 90-96.
Devereux, G. (2006). The increase in the prevalence of asthma and allergy: Food for thought. Nature Reviews Immunology, 6 (11), 869-874.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Risnes, K., Belanger, K., Murk, W., Bracken, M. (2010) Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children. American Journal of Epidemiology, 173, 3, 310-318.
.Sobko T, Schiött J, Ehlin A, Lundberg J, Montgomery S, Norman M. (2010). Neonatal sepsis, antibiotic therapy and later risk of asthma and allergy. Paediatr Perinat Epidemiol. 24(1):88-92.
Tantisira, K.G., & Weiss, S.T. (2006). The pharmacogenetics of asthma therapy. Current Drug Targets, 7 (12), 1697-1708.
Umetsu, D.T. & DeKruyff, R.H. (2006). The regulation of allergy and asthma. Immunological Reviews, 212 (1), 238-255.
Biological Basis
Asthma is a chronic disorder that is characterized by lung airway inflammation. This inflammation is caused and perpetuated by an inappropriate immune response, an increase in airway responsiveness, and airflow obstruction. Asthma symptoms can be mild, moderate, and severe and may include wheezing, cough, and chest tightness, among other life-threatening implications. Asthma and the closely associated allergic diseases of atopic dermatitis, allergic rhinitis, and immunoglobulin E-medicated food allergy are characterized by inflammatory T-helper cell responses of the T-helper 2 phenotype initiating and perpetuating symptoms (Devereux, 2006). Further mediators in the process include cytokines secreted by T-helper 2 cells, interleukin-4 and interleukin-13, which contribute to elevated immunoglobulin E, mast-cell regulation, and eosinophilic inflammation.
The prevalence of asthma as the world’s most common chronic disorder (Devereux, 2006) has encouraged a plethora of studies examining prenatal and postnatal exposures, environment, family history, and has resulted in an increase in awareness and subsequent diagnosis. The following discourse examines three such studies that pertain to medication exposure among infants and the association and subsequent development of asthma and allergies. Asthma predominates as a Western disease and the possible correlation between high medication usage and antibiotic usage, in particular, may depict the pitfalls of easy access and excess usage. As the following studies suggest, use of such common over-the-counter medications such as paracetamol and prescribed medications such as antibiotics in early childhood may result in a debilitating asthmatic disease requiring additional medications and/or medical attention. This seeming paradox, when adequately examined, illustrated, and exposed may result in the reduction of unintentional parentally and/or physician-induced asthma and allergies.
Research Findings
Bakkeheim et. al. (2010) examined the role of paracetamol in early infancy and the associated risk of developing childhood allergies and asthma. Paracetamol or acetaminophen is a common analgesic and antipyretic that is readily used on infants and children for fever, teething, and to alleviate general pain and discomfort. Commonly known as Tylenol, its label specifies, “Give your child Infants' Tylenol products to reduce fever and for the temporary relief of minor aches and pains associated with:Cold. Flu. Headache. Sore throat. Toothache and teething.” Its usage was examined in this prospective cohort study that included 1019 children at birth who were then reexamined at 10 years of age. Their prenatal exposure through maternal paracetamol use or postnatal exposure during the first 6 months of life were documented. Subsequent outcomes at the 10 year reexamination period included existing asthma diagnosis, a history of asthma, allergic sensitization, and/or allergic rhinitis.
Bakkeheim’s research resulted in the finding that maternal paracetomol use in the first trimester only increased the risk for allergic rhinitis with an odds ratio of 2.30 for both male and female children. The significant findings of the study related to paracetamol use until 6 months of age in girls, resulting in an increased risk of allergic sensitization (odds ratio of 2.20) and a history of asthma (odds ratio of 2.20 as well) in 10 year olds.
Further research by Risnes et. al. (2010) also examined the role of medication exposure in regards to antibiotic exposure within the first 6 months of life and the development of asthma and allergy at 6 years of age. This study included a cohort of 1401 children whose hospital records and physician records were examined to document antibiotic exposure. At 6 years of age, maternal interviews were conducted to determine whether the child had experienced an allergic reaction, if blood immunoglobulin E or a skin prink had been conducted, and the results of such testing. Those children who experienced an allergic reaction and had a positive blood or skin prick test were classified as allergy positive. Children diagnosed with asthma and who had a positive allergy test were determined to have allergic asthma.
The research findings included an increased risk of asthma (odds ratio of 1.52) among those children who had been prescribed antibiotics in infancy. The adverse effect of antibiotics use was particularly evident in children who had no family history of asthma (odds ratio 1.89). In addition, the odds ratio of a positive blood immunoglobulin E or skin prink test was 1.59 among those with early antibiotic exposure.
Sobko et. al. (2010) examined the role that neonatal sepsis and early antibiotic therapy have on bacterial colonization and immune activation in infancy and childhood. These were investigated for their implications in allergy and asthma development. This cohort study utilized a validated questionnaire by the International Study of Asthma and Allergies in Children. The three cohorts in this study that were screened examined different perinatal exposures of infection and medication exposure to antibiotics.
The research findings concluded that asthma was more prevalent after neonatal sepsis and antibiotic therapy with an adjusted odds ratio 1.63 as compared with a control group. Also documented was increased atopic eczema after neonatal sepsis (odds ratio 1.39). These findings resulted in the conclusion that neonatal sepsis is associated with an increased risk for later development of asthma and that early antibiotic exposure may be the contributing factor in this association. This study also examined the confounding bias that may occur in regards to infection and subsequent antibiotic use. Infection without the subsequent use of antibiotics did not result in the associated increase.
Public Health Application
All three studies addressed the development of childhood asthma as a result of medications (either paracetamol or antibiotics) given to children prior to 6 months of age. Collectively, they suggest that paracetamol and antibiotic usage may contribute to asthma and allergies. The public health application should pertain to preventing exposure to these medications during the 6 month infancy time-period and curbing exposure throughout early childhood. While public education efforts regarding the use of these medications in infancy is essential to curbing usage and limiting exposure, the particulars of paracetamol and antibiotics usage are unique in the way that these medications are distributed and can possibly be managed more effectively.
For example, in the use of paracetamol, the Tylenol Concentrated Infant Drops’ label specifies that its use for children under the age of 2 should be done with a doctor’s consultation. While this labeling may be intended to provide a caregiver with encouragement in contacting a child’s physician when a child is ill, this may not always occur. Therefore, specific dosing and age parameters are more efficient and useful guidelines. The label guidelines should specify that use in children less than 6 months of age has been associated with the development of asthma and allergy. Albeit this association was gender specific (Bakkenheim et. al., 2010), such considerations would need to be further researched prior to possibly ever attaching a gender-specific label to medication. In the event that a physician is contacted regarding use, the physician should adequately inform and encourage proper and limited usage.
Similar to paracetamol in that there are avenues to curbing usage, antibiotics have an additional barrier to usage, the physicians themselves. The distribution of prescriptions for antibiotic medications are limited to physicians and in some states, physicians’ assistants and registered nurses. Regardless of the persistence of parents/ caregivers, physician should address the issue of antibiotic over-prescription, especially among infants who may suffer the additional consequences of asthma and allergies. Patient awareness and education is a key contributing factor to reducing parental demand for antibiotics, but ultimately, it is a physician’s determination whether or not to prescribe antibiotics and to determine at what age they believe it is beneficial or detrimental to the current and future health status of their patients. Further physician education and awareness may also be a key component in reducing usage of antibiotics among infants.
References
Bakkehaim, E. , Mowincckel, P., Carlsen, K. H., Haland, G., Carlsen, K. (2010). Paracetamol in early infancy: the risk of childhood allergy and asthma. Acta Paediatricia, 100, 90-96.
Devereux, G. (2006). The increase in the prevalence of asthma and allergy: Food for thought. Nature Reviews Immunology, 6 (11), 869-874.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Risnes, K., Belanger, K., Murk, W., Bracken, M. (2010) Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children. American Journal of Epidemiology, 173, 3, 310-318.
.Sobko T, Schiött J, Ehlin A, Lundberg J, Montgomery S, Norman M. (2010). Neonatal sepsis, antibiotic therapy and later risk of asthma and allergy. Paediatr Perinat Epidemiol. 24(1):88-92.
Tantisira, K.G., & Weiss, S.T. (2006). The pharmacogenetics of asthma therapy. Current Drug Targets, 7 (12), 1697-1708.
Umetsu, D.T. & DeKruyff, R.H. (2006). The regulation of allergy and asthma. Immunological Reviews, 212 (1), 238-255.
Friday, April 8, 2011
Gattaca in Africa: The Unique Qualities of Sickle Cell Anemia
Sickle cell anemia (homozygous Hb SS) constitutes 60-70% of sickle cell disease in the United States (Bender et. al, 2009) affecting 90,000 -100,000 individuals (CDC, 2010) and is a fascinating example of the dynamic nature of genetic distribution, adaptation, and disorders. The term sickle cell disease encompasses a group of symptomatic disorders associated with mutations in the HBB gene (Bender et. al., 2009). The disease is defined by the presence of hemoglobin S which is a result of a point mutation in the HBB gene in which the sixth amino acid in the hemoglobin chain is changed from glutamic acid to valine. Sickle cell prevalence is also a result of natural selection in regions of endemic malaria. This condition is attributed with high survival rates for those infected with acute malaria and depicts how a genetic disorder can gain momentum.
Sickle cell anemia is a debilitating disease characterized by intermittent vaso-occlusive events and chronic hemolytic anemia. Common symptoms include attacks of acute and chronic abdominal pain, bone pain, breathlessness, delayed growth and puberty, fatigue, fever, rapid heart rate, ulcers, and jaundice. Current treatment consists of symptom management as the condition is chronic and life-threatening and may include folic acid supplementation to encourage red blood cell production, pain medication during crises, and routine blood transfusions. Bone marrow or stem cell transplants are considered risky, yet viable options to cure the disease.
Currently, transfusions are readily utilized to treat sickle cell patients in order to improve blood flow by reducing the proportion of red cells capable of forming the sickle hemoglobin polymer (Raghypathy, 2010). However, a major and unavoidable complication of transfusions in sickle cell disease is iron overload. Iron overload can damage organs and cause other severe symptoms. The risks associated with such treatment are not easily quantified as there is no national database for sickle cell anemia (CDC, 2010). Prevalence rates, health outcomes, and impact on quality of life are not documented. Although every newborn is screened for sickle cell anemia, a national registry has not been established. From a public health perspective the establishment of such a center and service would enable additional documentation and dissemination of information such as the risks associated with iron overload. Surveillance is a key public health tool that allows health professionals to monitor and address health issues, sickle cell anemia should not be immune to such ongoing examination.
References
Bender, MA, Hobbs, W. (2009) Sickle Cell Anemia, Gene Reviews.
Centers for Disease Control and Prevention. Sickle Cell Disease. Retrieved on April 6, 2011 from www.cdc.gov/ncbddd/blooddisorders/documents/BBV_PNV_C0_1159_Sickle_Cell_R1mtr.pdf.
Raghupathy, R., Manwani, D., Little, J. (2010) Iron Overload in Sickle Cell Disease. Adv. Hematol. 272940. doi: 10.1155/2010/272940
Sickle cell anemia is a debilitating disease characterized by intermittent vaso-occlusive events and chronic hemolytic anemia. Common symptoms include attacks of acute and chronic abdominal pain, bone pain, breathlessness, delayed growth and puberty, fatigue, fever, rapid heart rate, ulcers, and jaundice. Current treatment consists of symptom management as the condition is chronic and life-threatening and may include folic acid supplementation to encourage red blood cell production, pain medication during crises, and routine blood transfusions. Bone marrow or stem cell transplants are considered risky, yet viable options to cure the disease.
Currently, transfusions are readily utilized to treat sickle cell patients in order to improve blood flow by reducing the proportion of red cells capable of forming the sickle hemoglobin polymer (Raghypathy, 2010). However, a major and unavoidable complication of transfusions in sickle cell disease is iron overload. Iron overload can damage organs and cause other severe symptoms. The risks associated with such treatment are not easily quantified as there is no national database for sickle cell anemia (CDC, 2010). Prevalence rates, health outcomes, and impact on quality of life are not documented. Although every newborn is screened for sickle cell anemia, a national registry has not been established. From a public health perspective the establishment of such a center and service would enable additional documentation and dissemination of information such as the risks associated with iron overload. Surveillance is a key public health tool that allows health professionals to monitor and address health issues, sickle cell anemia should not be immune to such ongoing examination.
References
Bender, MA, Hobbs, W. (2009) Sickle Cell Anemia, Gene Reviews.
Centers for Disease Control and Prevention. Sickle Cell Disease. Retrieved on April 6, 2011 from www.cdc.gov/ncbddd/blooddisorders/documents/BBV_PNV_C0_1159_Sickle_Cell_R1mtr.pdf.
Raghupathy, R., Manwani, D., Little, J. (2010) Iron Overload in Sickle Cell Disease. Adv. Hematol. 272940. doi: 10.1155/2010/272940
Saturday, March 19, 2011
Sex and Candy
"Binge-drinking" has always been fascinating to me in terms of the tragedy and long-term effects this erratic and destructive behavior can cause. I had a tendency to believe that this was a development of college associated drinking where students would be under academic stress that encouraged sobriety until finals were over or the weekend arrived and would then consume inexplicable amounts of alcohol. This was until my understanding of high functioning alcoholism developed. Most alcoholics fall under this category (Benton, 2009) and may be increasingly resistant to treatment as they do not fall into most familiar categories of alcoholics (drinking alone, hiding alcohol consumption).
Although I really want to discus caffeine and sex addiction soon (albeit not as a composite), I find alcohol addiction especially intriguing as its history through prohibition, regulation, and socialization may be the mirror for all drug progression.
Benton , S. (2009) The High Functioning Alcoholic. Psychology Today. Accessed on March 17, 2011 from http://www.psychologytoday.com/blog/the-high-functioning-alcoholic/200904/social-drinkers-problem-drinkers-and-high-functioning-alc
Although I really want to discus caffeine and sex addiction soon (albeit not as a composite), I find alcohol addiction especially intriguing as its history through prohibition, regulation, and socialization may be the mirror for all drug progression.
Benton , S. (2009) The High Functioning Alcoholic. Psychology Today. Accessed on March 17, 2011 from http://www.psychologytoday.com/blog/the-high-functioning-alcoholic/200904/social-drinkers-problem-drinkers-and-high-functioning-alc
"Just because you've got the monkey off your back, doesn't mean the circus has left town." George Carlin
Addiction is a fascinating, multi-faceted, and demanding public health and medical dilemma. Johnson (2010) defines addiction as “the need to continue obtaining and using a chemical substance despite one’s better judgment and good intentions.” Used interchangeably with diagnostic terminology including substance abuse, substance dependence, or a substance-related disorders, addiction may stipulate an increasing tolerance to a substance and withdrawal systems when the substance is removed from the system, and compulsive drug-taking behavior (DSSM-IV-TR, 2000). Addiction may also be used to describe a condition, propensity, or disposition that is not necessarily accompanied by use or abuse of the substance.
Specific to drug addiction, the physiological capabilities of the chemical substance relates its ability to cross the blood-brain barrier in order to manipulate neural pathways and dopamine levels. This capability was most often initially recognized as valuable in terms of medical treatments, as most drugs were initially discovered, developed, and utilized for disease treatment. However, improper utilization, debilitating side-effects, and long-term brain damage as in the case of LSD and cocaine reclassified these substances as dangerous. Modern prescription medicines such as ritalin, vicodin, and oxycontin are also of concern in terms of their improper utilization and subsequent psychological and/or physiological dependence development.
In Hawai’i, numerous factors coincide to contribute to crystal methamphetamine’s addiction prevalence. These include being a powerful stimulant, highly addictive, its low price, the state’s geographic isolation which increases the cost of and reduces the availability of other drugs, inadequate drug education, and low per-capita income among at-risk populations and related support services (Hawaii Meth Project, 2010) .
Crystal methamphetamine can increase dopamine levels 1150% more than food and 850% more than cocaine (NIDA, 2010). Due to this disturbing ability, most methamphetamine efforts are focused on use prevention. Recent studies have further examined the role of support services in curtailing methamphetamine use and associated behavior. Menza et. al., (2010) determined that therapeutic measures such as contingency management are unlikely to have a sustained effect on methamphetamine use. Kenny et al., (2011) determined that treatment utilization was low due to perceptions of an individual’s self-management of meth addiction and suggested online treatments or specialist clinics.
These assessments for treatments in crystal methamphetamine addiction support current efforts that focus on prevention. From a public health perspective, prevention is always primary and in this instance, seems entirely and direly necessary.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Kenny, P., Harney, A., Lee, N., and Pennay, A. (February 2011) Treatment utilization and barriers to treatment: Results of a survey of dependent methamphetamine users. Subst Abuse Treat Prev Policy.6(1):3.
Menza, T., Jameson, D., Hughes,J., Colfax, G., Shoptaw, S., Golden, M. (December 2010) Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. BMC Public Health.10:774.
National Institute on Drug Abuse (2010) The Science of Addiction. Accessed on March 16, 2011 from http://www.nida.nih.gov/scienceofaddiction/sciofaddiction.pdf
The Hawaii Meth Project (2010) Hawaii Meth Use and Attitudes Survey 2010. Accessed on March 15, 2011 from http://www.hawaiimethproject.org/About_Us/publications.php.
Specific to drug addiction, the physiological capabilities of the chemical substance relates its ability to cross the blood-brain barrier in order to manipulate neural pathways and dopamine levels. This capability was most often initially recognized as valuable in terms of medical treatments, as most drugs were initially discovered, developed, and utilized for disease treatment. However, improper utilization, debilitating side-effects, and long-term brain damage as in the case of LSD and cocaine reclassified these substances as dangerous. Modern prescription medicines such as ritalin, vicodin, and oxycontin are also of concern in terms of their improper utilization and subsequent psychological and/or physiological dependence development.
In Hawai’i, numerous factors coincide to contribute to crystal methamphetamine’s addiction prevalence. These include being a powerful stimulant, highly addictive, its low price, the state’s geographic isolation which increases the cost of and reduces the availability of other drugs, inadequate drug education, and low per-capita income among at-risk populations and related support services (Hawaii Meth Project, 2010) .
Crystal methamphetamine can increase dopamine levels 1150% more than food and 850% more than cocaine (NIDA, 2010). Due to this disturbing ability, most methamphetamine efforts are focused on use prevention. Recent studies have further examined the role of support services in curtailing methamphetamine use and associated behavior. Menza et. al., (2010) determined that therapeutic measures such as contingency management are unlikely to have a sustained effect on methamphetamine use. Kenny et al., (2011) determined that treatment utilization was low due to perceptions of an individual’s self-management of meth addiction and suggested online treatments or specialist clinics.
These assessments for treatments in crystal methamphetamine addiction support current efforts that focus on prevention. From a public health perspective, prevention is always primary and in this instance, seems entirely and direly necessary.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Kenny, P., Harney, A., Lee, N., and Pennay, A. (February 2011) Treatment utilization and barriers to treatment: Results of a survey of dependent methamphetamine users. Subst Abuse Treat Prev Policy.6(1):3.
Menza, T., Jameson, D., Hughes,J., Colfax, G., Shoptaw, S., Golden, M. (December 2010) Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. BMC Public Health.10:774.
National Institute on Drug Abuse (2010) The Science of Addiction. Accessed on March 16, 2011 from http://www.nida.nih.gov/scienceofaddiction/sciofaddiction.pdf
The Hawaii Meth Project (2010) Hawaii Meth Use and Attitudes Survey 2010. Accessed on March 15, 2011 from http://www.hawaiimethproject.org/About_Us/publications.php.
Wednesday, March 16, 2011
Island Roots by my father...
A Hawaii Island Story: Aiko & Co.
There is no end to enriching Hawaii Island stories. Here's a Hawaii Island story that (so far)begins in the ranchlands of Waimea and winds up on Broadway, with innumerable tangents running to Kohala and Hilo and the Hamakua Coast, to Maui and Kauai, to Oahu and Hawaii's first Chinese millionaire (Chun Afong), to a famous writer (Jack London), and to a popular film actor (Keanu Reeves). It all begins here on Hawaii Island in Waimea.
Intuitively, most people who know anything about the now defunct sugar industry on Hawaii Island would readily believe it began on the Hamakua Coast. Not so; wrong. It began in Waimea in probably what is today known as the Lalamilo Farm Lots. About 250 acres. Not to be confused with Kauai, it was called the Lihue Plantation, irrigated by the Waikoloa Stream that runs through Waimea Town (behind KTA, next to Parker School, behind the Catholic and Episcopal Churches, and through Waimea Nature Park). The proposed Waimea Trail will run along the Waikoloa Stream from Church Row on down to a proposed park near the Waimea rubbish transfer station just off the Kawaihae Road.
In early Hawaiian times, Waimea was a place of streams and climates that ran from wet to dry - ideal, as it is today, for growing a variety of foods. The Waikoloa Stream is usually dry these days because the water has been diverted into reservoirs above Waimea to meet the town's need for drinking water. In 2004, however, due to obstruction upstream during heavy rains, the Waikoloa Stream flooded the town.
The area that became the Lihue Plantation was once controlled by Governor Kuakini who built the "Hulihee Palace" in Kailua-Kona. This was a time when all land belonged to the king, a time before the foreign concept of private land ownership was introduced, before the Mahele led to earthshaking change which is a whole different story in itself. What became known as the Lihuie Plantation was started by Chinese during the mid-1830s, specifically by Aiko (Lum Ah Jo), one of the original tongsee (sugar masters).
There were only about half a dozen tongsee. A few went to Kauai. It seems Aiko went there first, but the Governor of Kauai was not so accommodating. Somehow, Aiko wound up on Hawaii Island.
Sugarcane grew wild in Hawaii before Captain Cook arrived in 1778 and some of this wild cane was ground in stone mills powered by oxen going round and round. The juice was boiled down in stages into sugar. This occurred earlier, in the early 1800s. The first Chinese mill began on Lanai but this operation ran for only about one year.
The tongsee who came later during the 1830s established organized plantations that cultivated cane. The tongsee had, and coveted, the technique of grinding (squeezing) the cane stalks and boiling the juice down into sugar crystals. The Chinese started small sugar plantations on Hawaii Island which grew and were later consolidated into the larger plantations that operated up to the 1990s. Most of those early Chinese eventually became increasingly involved in acquiring and selling (and gifting) lands, and in early small businesses. Note that the first contract sugar laborers who came to Hawaii were Chinese, but they did not arrive until much later, in 1852.
Aiko sold his plantation around 1840 to Abram Feyerweather, an American who married into Hawaiian royalty. His daughter, Julia, in 1857, married a merchant in Oahu who became the first Chinese millionaire in Hawaii, Chun Afong. He and other Chinese are known to have thrown a big celebration for King Kalakaua. There is a marker on the Waikiki Trail, like the Duke Kahanamoku marker, at the spot where the Afong Villa (a mansion) once stood.
Chun and Julia Afong had 12 sons and 4 daughters. The life of Chun Afong inspired Jack London's short story Chun Ah Chun. Much later, this story morphed into the 1961 Broadway musical 13 Daughters written with music and lyrics by Eaton Magoon Jr. who is related to Julia. Don Ameche had the lead role. Keola Beamer had a part and his mother, Nona Beamer, was Hawaiian consultant. The show didn't run very long. One comment is that it ran too soon after the very successful 7 Brides for 7 Brothers.
Aiko married a Hawaiian woman from the Waimea area in 1835 and they had a daughter, Amelia Akoi, born in 1836. Aiko's wife, Maria Kaahuapea, probably from the Waimea area, was baptized a Catholic in 1840 during a time when Catholics were not very welcomed in Hawaii. Amelia was their only natural child. They raised other children, hanai and adopted.
After selling the Waimea plantation to Abram Feyerweather, Aiko started another plantation in Kohala, near Kapaau where the original Kamehameha Statue (one of five such statues) is located, in the area known as Iole (rat), very close to the distinctive Kalahikiola Church which was severely damaged in the 2006 earthquak but has since been restored, of Reverend Elias Bond who served the area in various capacities for over 50 years. Aiko's plantation was also close to the Kohala Girls School, an intriguing boarding complex which ceased to operate perhaps during the 1940s. In more recent years, it has been nicely restored and renovated and is being used as a private cultural center that welcomes the general public. The nearby original Bond Estate is also a feature of the area.
Aiko next moved down to Hilo where he with other Chinese started a plantation on Ponohawai. And he started other plantations in the areas of Amauulu, Paukaa, Onomea/Papaikou. Incidentally, Chun Afong had an interest in a plantation in Pepeekeo. Aiko had the first bowling alley in Hilo and was involved in other businesses including inter-island shipping. He owned or controlled various properties. Aiko became a Catholic late in life and gifted land to St. Joseph's Church.
Aiko's and Maria Kaahuapea's daughter, Amelia Akoi, married half-Hawaiian half-Chinese Wikoli (Victor) Kamukai. Both Amelia and Wikoli were born in 1836. When Wikoli was baptized a Christian, legend says he turned his name around to call himself Kamukai Victor. They had 11 (or 12?) children. This is how the Victors of Hilo began whose names are seen in various places around town including St. Joseph's School gym where a Victor was a well-known and much loved coach, not only there but elsewhere in Hilo where he served various sports and teams.
Incidentally, but notably, Kamukai Victor's signature, along with the signatures of other Victors, are found in the Ku'e: The Hui Aloha 'Aina Anti-Annexation Petitions 1897-1898. His age is stated as 64 years. This petition, submitted to William McKinley as President of the US Senate stated, ". . . earnestly protest against the said Hawaiian Islands to the said United States of America."
In Hilo, between the Hongwanji temple and Starbucks on Kilauea Avenue in Hilo there are two property lots. Today, one of the two, adjacent to Starbucks, is a parking lot for the Sangha Hall in the rear. The other, adjacent to the temple, is today a financial services office. Both properties once belonged to Aiko. About 10 years ago an old heritage house on what is today's parking lot was, unfortunately and regrettably, torn down.
The home was affectionately known as "Termite Tavern", a gathering place for the Victor family and friends. Aiko, born in China in 1799, died in that house in 1895 - he was blind and still had his Chinese-style hair queue. He is buried in the small, unkempt St. Joseph's Cemetery behind Hilo Terrace Apartments on Waianuenue Avenue. His tombstone is in one of the corners in a plot with other Victor family members.
One of the 11 original Victors, Joseph Aiona Victor, is a direct ancestor of Keanu Charles Reeves who is a sixth generation Victor. (Keanu has a sister, Kim Sarah Makakapu Reeves, and a half-sister Emma Kauluwehionalani Victor.) Born in 1964 in Beirut, Keanu's father was Hawaiian-Chinese-?? and his mother was English. His grandmother, Mrs. Sarah Momilani Victor, born 1923, lives in Hawaii and attends the biennial Victor 'Ohana Reunion.
Another of the 11 original Victor children married an Englishman-Scot (Watson) and they had 14 (or 16 or 18?) children who are directly related to "Huggo's" of Kailua-Kona (von Platen Luder), Honolulu Mayor Neil Blaisdell, the Thurstons, and other familiar names of Hawaii.
One of the 14 married a Hawaiian-Portuguese (Henry William Moniz) who worked for the then Hilo Tribune-Herald for exactly 50 years (1909-1959). Legend has it he never took a day of sick leave. Old timers in Hilo say people were like that in those days. His wife, Ethel (Watson) Moniz, worked for Consolidated Amusement Company (Palace and Hilo Theatres) for some 30+ years. They lived in the other Victor Estate house next to the Hongwanji temple where there is a financial services office today. (The 1960 tsunami terminated just opposite on the makai side of Kilauea Avenue which was half as wide at that time.)
There is always more to the story, the rest of the story, and the whole story. But this is some of the story. It begins in Waimea and goes all around Hawaii Island, to Honolulu, to Maui and Kauai where there are more Victors, to the mainland including Broadway, and beyond to Beirut and wherevah.
Here are a few reference sources:
1974 issue of the Hawaiian Journal of History has a lot on the early Chinese to Hawaii Islandof Hawaii, notably of Aiko and the Lihue Plantation. The 1974 journal is available at the Hilo Public Library and the Thelma Parker Memorial Library in Waimea. Aiko is also mentioned in many other books and articles including Kohala Aina, and Wayne Subica's "Mom & Pop" collections.
November 1986 issue of Honolulu Magazine (available in the Hilo Public Library), has an article by Bob Dye on Abram Feyerweather, Lihue - The Lost Plantation. Over some 50 years author, historian, and journalist Bob Dye wrote many articles published by the Honolulu Advertiser and Honolulu Magazine. He was an aide to the irascible steamroller Honolulu Mayor Frank Fasi. From a Google source: "He wrote countless political and historical articles and edited the three-volume set, Hawaii Chronicles: Island History from the pages of HONOLULU Magazine. That’s not to mention his own books, including a novel, Humble Honest Men, and Merchant Prince of the Sandalwood Mountains, the fascinating story of his wife's, Tessa’s, great-great-grandfather, Chun Afong, Hawaii’s first Chinese millionaire." Dye passed away about a year ago.
Jack London's fictionalized biography of Chun Afong, Chun Ah Chun is available at: http://www.classicreader.com/book/676/1/)
Jack London's short story is the inspiration of the 1961 Broadway musical 13 Daughters starring Don Ameche, written with music and lyrics by Eaton Magoon Jr. Keola Beamer had a part. His mother, Nona Beamer, was Hawaiian consultant.
See: http://broadwaybuffet.wetpaint.com/page/13+Daughters
There's is a Victor 'Ohana website: http://www.victor-ohana.org/
Question: Who was Maria Kaahuapea? Who was her family? Where did she come from? What's HER story?
There is no end to enriching Hawaii Island stories. Here's a Hawaii Island story that (so far)begins in the ranchlands of Waimea and winds up on Broadway, with innumerable tangents running to Kohala and Hilo and the Hamakua Coast, to Maui and Kauai, to Oahu and Hawaii's first Chinese millionaire (Chun Afong), to a famous writer (Jack London), and to a popular film actor (Keanu Reeves). It all begins here on Hawaii Island in Waimea.
Intuitively, most people who know anything about the now defunct sugar industry on Hawaii Island would readily believe it began on the Hamakua Coast. Not so; wrong. It began in Waimea in probably what is today known as the Lalamilo Farm Lots. About 250 acres. Not to be confused with Kauai, it was called the Lihue Plantation, irrigated by the Waikoloa Stream that runs through Waimea Town (behind KTA, next to Parker School, behind the Catholic and Episcopal Churches, and through Waimea Nature Park). The proposed Waimea Trail will run along the Waikoloa Stream from Church Row on down to a proposed park near the Waimea rubbish transfer station just off the Kawaihae Road.
In early Hawaiian times, Waimea was a place of streams and climates that ran from wet to dry - ideal, as it is today, for growing a variety of foods. The Waikoloa Stream is usually dry these days because the water has been diverted into reservoirs above Waimea to meet the town's need for drinking water. In 2004, however, due to obstruction upstream during heavy rains, the Waikoloa Stream flooded the town.
The area that became the Lihue Plantation was once controlled by Governor Kuakini who built the "Hulihee Palace" in Kailua-Kona. This was a time when all land belonged to the king, a time before the foreign concept of private land ownership was introduced, before the Mahele led to earthshaking change which is a whole different story in itself. What became known as the Lihuie Plantation was started by Chinese during the mid-1830s, specifically by Aiko (Lum Ah Jo), one of the original tongsee (sugar masters).
There were only about half a dozen tongsee. A few went to Kauai. It seems Aiko went there first, but the Governor of Kauai was not so accommodating. Somehow, Aiko wound up on Hawaii Island.
Sugarcane grew wild in Hawaii before Captain Cook arrived in 1778 and some of this wild cane was ground in stone mills powered by oxen going round and round. The juice was boiled down in stages into sugar. This occurred earlier, in the early 1800s. The first Chinese mill began on Lanai but this operation ran for only about one year.
The tongsee who came later during the 1830s established organized plantations that cultivated cane. The tongsee had, and coveted, the technique of grinding (squeezing) the cane stalks and boiling the juice down into sugar crystals. The Chinese started small sugar plantations on Hawaii Island which grew and were later consolidated into the larger plantations that operated up to the 1990s. Most of those early Chinese eventually became increasingly involved in acquiring and selling (and gifting) lands, and in early small businesses. Note that the first contract sugar laborers who came to Hawaii were Chinese, but they did not arrive until much later, in 1852.
Aiko sold his plantation around 1840 to Abram Feyerweather, an American who married into Hawaiian royalty. His daughter, Julia, in 1857, married a merchant in Oahu who became the first Chinese millionaire in Hawaii, Chun Afong. He and other Chinese are known to have thrown a big celebration for King Kalakaua. There is a marker on the Waikiki Trail, like the Duke Kahanamoku marker, at the spot where the Afong Villa (a mansion) once stood.
Chun and Julia Afong had 12 sons and 4 daughters. The life of Chun Afong inspired Jack London's short story Chun Ah Chun. Much later, this story morphed into the 1961 Broadway musical 13 Daughters written with music and lyrics by Eaton Magoon Jr. who is related to Julia. Don Ameche had the lead role. Keola Beamer had a part and his mother, Nona Beamer, was Hawaiian consultant. The show didn't run very long. One comment is that it ran too soon after the very successful 7 Brides for 7 Brothers.
Aiko married a Hawaiian woman from the Waimea area in 1835 and they had a daughter, Amelia Akoi, born in 1836. Aiko's wife, Maria Kaahuapea, probably from the Waimea area, was baptized a Catholic in 1840 during a time when Catholics were not very welcomed in Hawaii. Amelia was their only natural child. They raised other children, hanai and adopted.
After selling the Waimea plantation to Abram Feyerweather, Aiko started another plantation in Kohala, near Kapaau where the original Kamehameha Statue (one of five such statues) is located, in the area known as Iole (rat), very close to the distinctive Kalahikiola Church which was severely damaged in the 2006 earthquak but has since been restored, of Reverend Elias Bond who served the area in various capacities for over 50 years. Aiko's plantation was also close to the Kohala Girls School, an intriguing boarding complex which ceased to operate perhaps during the 1940s. In more recent years, it has been nicely restored and renovated and is being used as a private cultural center that welcomes the general public. The nearby original Bond Estate is also a feature of the area.
Aiko next moved down to Hilo where he with other Chinese started a plantation on Ponohawai. And he started other plantations in the areas of Amauulu, Paukaa, Onomea/Papaikou. Incidentally, Chun Afong had an interest in a plantation in Pepeekeo. Aiko had the first bowling alley in Hilo and was involved in other businesses including inter-island shipping. He owned or controlled various properties. Aiko became a Catholic late in life and gifted land to St. Joseph's Church.
Aiko's and Maria Kaahuapea's daughter, Amelia Akoi, married half-Hawaiian half-Chinese Wikoli (Victor) Kamukai. Both Amelia and Wikoli were born in 1836. When Wikoli was baptized a Christian, legend says he turned his name around to call himself Kamukai Victor. They had 11 (or 12?) children. This is how the Victors of Hilo began whose names are seen in various places around town including St. Joseph's School gym where a Victor was a well-known and much loved coach, not only there but elsewhere in Hilo where he served various sports and teams.
Incidentally, but notably, Kamukai Victor's signature, along with the signatures of other Victors, are found in the Ku'e: The Hui Aloha 'Aina Anti-Annexation Petitions 1897-1898. His age is stated as 64 years. This petition, submitted to William McKinley as President of the US Senate stated, ". . . earnestly protest against the said Hawaiian Islands to the said United States of America."
In Hilo, between the Hongwanji temple and Starbucks on Kilauea Avenue in Hilo there are two property lots. Today, one of the two, adjacent to Starbucks, is a parking lot for the Sangha Hall in the rear. The other, adjacent to the temple, is today a financial services office. Both properties once belonged to Aiko. About 10 years ago an old heritage house on what is today's parking lot was, unfortunately and regrettably, torn down.
The home was affectionately known as "Termite Tavern", a gathering place for the Victor family and friends. Aiko, born in China in 1799, died in that house in 1895 - he was blind and still had his Chinese-style hair queue. He is buried in the small, unkempt St. Joseph's Cemetery behind Hilo Terrace Apartments on Waianuenue Avenue. His tombstone is in one of the corners in a plot with other Victor family members.
One of the 11 original Victors, Joseph Aiona Victor, is a direct ancestor of Keanu Charles Reeves who is a sixth generation Victor. (Keanu has a sister, Kim Sarah Makakapu Reeves, and a half-sister Emma Kauluwehionalani Victor.) Born in 1964 in Beirut, Keanu's father was Hawaiian-Chinese-?? and his mother was English. His grandmother, Mrs. Sarah Momilani Victor, born 1923, lives in Hawaii and attends the biennial Victor 'Ohana Reunion.
Another of the 11 original Victor children married an Englishman-Scot (Watson) and they had 14 (or 16 or 18?) children who are directly related to "Huggo's" of Kailua-Kona (von Platen Luder), Honolulu Mayor Neil Blaisdell, the Thurstons, and other familiar names of Hawaii.
One of the 14 married a Hawaiian-Portuguese (Henry William Moniz) who worked for the then Hilo Tribune-Herald for exactly 50 years (1909-1959). Legend has it he never took a day of sick leave. Old timers in Hilo say people were like that in those days. His wife, Ethel (Watson) Moniz, worked for Consolidated Amusement Company (Palace and Hilo Theatres) for some 30+ years. They lived in the other Victor Estate house next to the Hongwanji temple where there is a financial services office today. (The 1960 tsunami terminated just opposite on the makai side of Kilauea Avenue which was half as wide at that time.)
There is always more to the story, the rest of the story, and the whole story. But this is some of the story. It begins in Waimea and goes all around Hawaii Island, to Honolulu, to Maui and Kauai where there are more Victors, to the mainland including Broadway, and beyond to Beirut and wherevah.
Here are a few reference sources:
1974 issue of the Hawaiian Journal of History has a lot on the early Chinese to Hawaii Islandof Hawaii, notably of Aiko and the Lihue Plantation. The 1974 journal is available at the Hilo Public Library and the Thelma Parker Memorial Library in Waimea. Aiko is also mentioned in many other books and articles including Kohala Aina, and Wayne Subica's "Mom & Pop" collections.
November 1986 issue of Honolulu Magazine (available in the Hilo Public Library), has an article by Bob Dye on Abram Feyerweather, Lihue - The Lost Plantation. Over some 50 years author, historian, and journalist Bob Dye wrote many articles published by the Honolulu Advertiser and Honolulu Magazine. He was an aide to the irascible steamroller Honolulu Mayor Frank Fasi. From a Google source: "He wrote countless political and historical articles and edited the three-volume set, Hawaii Chronicles: Island History from the pages of HONOLULU Magazine. That’s not to mention his own books, including a novel, Humble Honest Men, and Merchant Prince of the Sandalwood Mountains, the fascinating story of his wife's, Tessa’s, great-great-grandfather, Chun Afong, Hawaii’s first Chinese millionaire." Dye passed away about a year ago.
Jack London's fictionalized biography of Chun Afong, Chun Ah Chun is available at: http://www.classicreader.com/book/676/1/)
Jack London's short story is the inspiration of the 1961 Broadway musical 13 Daughters starring Don Ameche, written with music and lyrics by Eaton Magoon Jr. Keola Beamer had a part. His mother, Nona Beamer, was Hawaiian consultant.
See: http://broadwaybuffet.wetpaint.com/page/13+Daughters
There's is a Victor 'Ohana website: http://www.victor-ohana.org/
Question: Who was Maria Kaahuapea? Who was her family? Where did she come from? What's HER story?
Thursday, March 10, 2011
Plaque and Poverty
Atherosclerosis is characterized by the deposition of plaque in the form of fatty substances such as cholesterol in the innermost layer of the arterial wall. This plaque deposition causes the arteries to narrow, constricting blood flow. Significant narrowing can either diminish or stop blood flow to the heart, causing angina, myocardial infarction, dyspnea, among other conditions.
Risk factors for atherosclerosis include diabetes, heavy alcohol use, high blood pressure, high blood cholesterol levels, high-fat diet, increasing age, obesity, personal or family history of heart disease, and smoking (PubMed Health, 2011). These risk factors predominantly concern diet, exercise, and lifestyle. These components are continually emphasized as integral to health maintenance and management and are such influential contributor’s to an individual’s health. Berg et. al. (2005) specify obesity as a risk factor for systemic inflammation which cause atherosclerosis whereas weight loss decreases systemic inflammation and reduces the risk. This makes evident that the risk factors associated with atherosclerosis, even ones as complicated as obesity, can be modified and eliminated through modification of diet, exercise, and lifestyle.
This emphasis on diet, exercise, and lifestyle can oftentimes be seen as a privilege for those who are of a certain socio-economic strata. Packard et. al.(2011) sought to assess socio-economic adversity as a risk factor for atherosclerosis. While their research concluded that chronic inflammation was a correlating factor influenced by the father’s occupation and childhood home conditions, it encouraged that efforts should be made to reduce the “health divide” and public health should be invested in determining that these health disparities diminish. Utilizing their data for specific socio-economic risk factors may enhance health care workers’ ability to address early onset of such diseases and promote health lifestyle more effectively.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Diseases Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Packard CJ, Bezlyak V, McLean JS, Batty GD, Ford I, Burns H, Cavanagh J, Deans KA, Henderson M, McGinty A, Millar K, Sattar N, Shiels PG, Velupillai YN, Tannahill C. (January 2011) Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid atherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study.BMC Public Health, 11, 42.
PubMed Health (2011) Diseases and Conditions: Atherosclerosis. Accessed on March 9, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/
Risk factors for atherosclerosis include diabetes, heavy alcohol use, high blood pressure, high blood cholesterol levels, high-fat diet, increasing age, obesity, personal or family history of heart disease, and smoking (PubMed Health, 2011). These risk factors predominantly concern diet, exercise, and lifestyle. These components are continually emphasized as integral to health maintenance and management and are such influential contributor’s to an individual’s health. Berg et. al. (2005) specify obesity as a risk factor for systemic inflammation which cause atherosclerosis whereas weight loss decreases systemic inflammation and reduces the risk. This makes evident that the risk factors associated with atherosclerosis, even ones as complicated as obesity, can be modified and eliminated through modification of diet, exercise, and lifestyle.
This emphasis on diet, exercise, and lifestyle can oftentimes be seen as a privilege for those who are of a certain socio-economic strata. Packard et. al.(2011) sought to assess socio-economic adversity as a risk factor for atherosclerosis. While their research concluded that chronic inflammation was a correlating factor influenced by the father’s occupation and childhood home conditions, it encouraged that efforts should be made to reduce the “health divide” and public health should be invested in determining that these health disparities diminish. Utilizing their data for specific socio-economic risk factors may enhance health care workers’ ability to address early onset of such diseases and promote health lifestyle more effectively.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Diseases Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Packard CJ, Bezlyak V, McLean JS, Batty GD, Ford I, Burns H, Cavanagh J, Deans KA, Henderson M, McGinty A, Millar K, Sattar N, Shiels PG, Velupillai YN, Tannahill C. (January 2011) Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid atherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study.BMC Public Health, 11, 42.
PubMed Health (2011) Diseases and Conditions: Atherosclerosis. Accessed on March 9, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/
Tuesday, March 8, 2011
A letter the Tooth Fairy left for my son
Dear Isaiah,
First of all, let me explain something very important, a rule #1 for all of your life:
WHATEVER YOU BELIEVE IN WILL COME TRUE.
If you believe in goodness, in your intelligence, your kindness, your creativity, your honor, your joy, your brilliance - it will be with you forever.
Conversely, if you believe in sadness, your inability, jealously, meanness- it will also be with you.
Same goes for the Tooth Fairy, Parking Fairy, Cookie Fairy, Homework Fairy, Christmas Fairies, Easter Bunny, St. Nicholas, and Santa Claus. Whatever you believe in will be with you forever.
Some people fell inspired by these fairies, saints, bunnies, bats, and kind people to perpetuate their kindness- that means making their kindness go on forever through their own actions.
Yes, your parents, grandparents, aunts, teachers, uncles, and the good part of society at large are all real people who perpetuate the goodness of what THEY believe.
It is truly up to you. Believe in good and the goodness in you and it is yours. Believe in other things, same rule applies.
Totally and completely your choice.
I know that people like your mother believe in fairies because it makes her life funner and full of magic when she believes that there are good little spirits all around us who want us to be happy and joyful always.
Life is magical and a gift. The gift is you and your ability to make your life whatever you wish it. There are angels and all the goodness in the world supporting you and guiding you each and every day. Be it into becoming a rocket scientist, a master blaster, a myth-buster, an engineer, a singer, a tennis player, and artist, an athlete, a father, or all of them at once.
You are the king of your castle, the master of your universe, and the writer of your own life story.
Thank you for all that you are and all that you are becoming.
We are ALL so proud of you.
Thank God for blessing you and keeping you safe. We all love you!
The Tooth Fairy, Santa Claus, The Easter Bunny Hop Hop, Christmas fairies, St. Nick, Etc......
First of all, let me explain something very important, a rule #1 for all of your life:
WHATEVER YOU BELIEVE IN WILL COME TRUE.
If you believe in goodness, in your intelligence, your kindness, your creativity, your honor, your joy, your brilliance - it will be with you forever.
Conversely, if you believe in sadness, your inability, jealously, meanness- it will also be with you.
Same goes for the Tooth Fairy, Parking Fairy, Cookie Fairy, Homework Fairy, Christmas Fairies, Easter Bunny, St. Nicholas, and Santa Claus. Whatever you believe in will be with you forever.
Some people fell inspired by these fairies, saints, bunnies, bats, and kind people to perpetuate their kindness- that means making their kindness go on forever through their own actions.
Yes, your parents, grandparents, aunts, teachers, uncles, and the good part of society at large are all real people who perpetuate the goodness of what THEY believe.
It is truly up to you. Believe in good and the goodness in you and it is yours. Believe in other things, same rule applies.
Totally and completely your choice.
I know that people like your mother believe in fairies because it makes her life funner and full of magic when she believes that there are good little spirits all around us who want us to be happy and joyful always.
Life is magical and a gift. The gift is you and your ability to make your life whatever you wish it. There are angels and all the goodness in the world supporting you and guiding you each and every day. Be it into becoming a rocket scientist, a master blaster, a myth-buster, an engineer, a singer, a tennis player, and artist, an athlete, a father, or all of them at once.
You are the king of your castle, the master of your universe, and the writer of your own life story.
Thank you for all that you are and all that you are becoming.
We are ALL so proud of you.
Thank God for blessing you and keeping you safe. We all love you!
The Tooth Fairy, Santa Claus, The Easter Bunny Hop Hop, Christmas fairies, St. Nick, Etc......
Friday, March 4, 2011
Rapid Fire Test
Having grown up in the developing world, I may be one of the greatest (yet quietest) proponents of vaccinations. My wonderful boss currently has the flu. He abstains from the flu shot. I abstain from pestering him about it.
The influenza virus is as “common” as a cold. Yet, it ability to cause havoc among the mammalian and avian population is unique. This acute viral illness is diagnosed by infection of an influenza virus, lungs, and airways and is characterized by the following symptoms malaise, myalgias, headache, cough, fever, runny nose, and sore throat. Two main types of the virus, type A and type B, cause illness amongst human (Urban, 2009). This severe illness results in an estimated 35,000 - 50,000 deaths in the United States and 250,000 – 500,000 world-wide per annum (Thompson, et. al., 2009).
The specific biological mechanisms that enable such wide-spread disease consist of the orthomyxovirus proteins hemagglutinin (HA) and neuraminidase (NA) and are pleiomorphic. These molecular components are coupled with their ability to alter their antigenic protein. This ability, antigenic drift, affects host specificity which can lead to more efficient transmission among humans. This greater efficiency can also cause pandemics.
Vaccines are continually promoted as an effective measure in regards to controlling influenza outbreaks. In regards to the highly virulent and pathogenic avian influenza virus (AIV), an FDA approved vaccine currently exists and is stockpiled in the event of human to human transmission. This much feared and anticipated event would be devastating and rapid detection would be necessary to inoculate the affected area prior to its global spread (Dhumpa, 2011). Recent efforts have focused on rapid detection as existing methods that rely on sample preparation of viral RNA extraction and purification from bird droppings are laborious and can take 3-7 days. Dhumpa et. al., examined immunoseperation and purification of AIV from chicken fecal samples that takes 30 minutes. Their detection of 100% of the AIV samples indicated that more efficient, less labor intensive, time-saving, and would be crucial in the event of an AIV human to human transmission. Utilizing their reaction assay to detect AIV in the field would allow public health workers to concentrate their efforts in vaccinating affected populations rapidly. This could ultimately prevent an AIV pandemic.
Centers for Disease Control (2010) Estimates of Deaths Associated with Seasonal Influenza--- United States 1976-2007Morbidity and Mortality Weekly, 59,33, 1057-1062. Accessed on March 3, 2011 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a1.htm?s_cid=mm5933a1_e%0
Dhumpa, R., Handburg, K., Jorgensen, P., Yi, S., Wolff, A., Bang, D. (2010) Rapid detection of avian influenza virus in chicken fecal samples by immunomagnetic capture reverse transcriptase-polymerase chain reaction assay. Diagnostic Microbiology and Infectious Disease, 69, 258-265.
Taubenberger, J. (2006) The Origin and Virulence of the 1918 “Spanish” Influenza Virus. Proceedings of the American Philosophical Society, 150, 86-112.
Thompson, W., Moore, M., Weintraub E. Estimating influenza-associated deaths in the United States. American Journal of Public Health,99, 225-230.
Urban, M. (2009). Influenza. Merck Manual of Medical Information.Accessed March 1, 2011, from: http://www.merckmanuals.com/home/print/sec17/ch198/ch198d.html
Nichol, K. L., & Treanor, J. J. (2006). Vaccines for seasonal and pandemic influenza.
Journal of Infectious Diseases, 94, S111–S118.
Thomas, J. K., & Noppenberger, J. (2007) Avian influenza: A review. American Journal of Health‐System Pharmacy, 64(2), 149–165.
Thompson, W. W., Comanor, L., & Shay, D. K. (2006). Epidemiology of seasonal influenza: Use of surveillance data and statistical models to estimate the burden of disease.
Journal of Infectious Diseases, 194, S82–S91.
The influenza virus is as “common” as a cold. Yet, it ability to cause havoc among the mammalian and avian population is unique. This acute viral illness is diagnosed by infection of an influenza virus, lungs, and airways and is characterized by the following symptoms malaise, myalgias, headache, cough, fever, runny nose, and sore throat. Two main types of the virus, type A and type B, cause illness amongst human (Urban, 2009). This severe illness results in an estimated 35,000 - 50,000 deaths in the United States and 250,000 – 500,000 world-wide per annum (Thompson, et. al., 2009).
The specific biological mechanisms that enable such wide-spread disease consist of the orthomyxovirus proteins hemagglutinin (HA) and neuraminidase (NA) and are pleiomorphic. These molecular components are coupled with their ability to alter their antigenic protein. This ability, antigenic drift, affects host specificity which can lead to more efficient transmission among humans. This greater efficiency can also cause pandemics.
Vaccines are continually promoted as an effective measure in regards to controlling influenza outbreaks. In regards to the highly virulent and pathogenic avian influenza virus (AIV), an FDA approved vaccine currently exists and is stockpiled in the event of human to human transmission. This much feared and anticipated event would be devastating and rapid detection would be necessary to inoculate the affected area prior to its global spread (Dhumpa, 2011). Recent efforts have focused on rapid detection as existing methods that rely on sample preparation of viral RNA extraction and purification from bird droppings are laborious and can take 3-7 days. Dhumpa et. al., examined immunoseperation and purification of AIV from chicken fecal samples that takes 30 minutes. Their detection of 100% of the AIV samples indicated that more efficient, less labor intensive, time-saving, and would be crucial in the event of an AIV human to human transmission. Utilizing their reaction assay to detect AIV in the field would allow public health workers to concentrate their efforts in vaccinating affected populations rapidly. This could ultimately prevent an AIV pandemic.
Centers for Disease Control (2010) Estimates of Deaths Associated with Seasonal Influenza--- United States 1976-2007Morbidity and Mortality Weekly, 59,33, 1057-1062. Accessed on March 3, 2011 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a1.htm?s_cid=mm5933a1_e%0
Dhumpa, R., Handburg, K., Jorgensen, P., Yi, S., Wolff, A., Bang, D. (2010) Rapid detection of avian influenza virus in chicken fecal samples by immunomagnetic capture reverse transcriptase-polymerase chain reaction assay. Diagnostic Microbiology and Infectious Disease, 69, 258-265.
Taubenberger, J. (2006) The Origin and Virulence of the 1918 “Spanish” Influenza Virus. Proceedings of the American Philosophical Society, 150, 86-112.
Thompson, W., Moore, M., Weintraub E. Estimating influenza-associated deaths in the United States. American Journal of Public Health,99, 225-230.
Urban, M. (2009). Influenza. Merck Manual of Medical Information.Accessed March 1, 2011, from: http://www.merckmanuals.com/home/print/sec17/ch198/ch198d.html
Nichol, K. L., & Treanor, J. J. (2006). Vaccines for seasonal and pandemic influenza.
Journal of Infectious Diseases, 94, S111–S118.
Thomas, J. K., & Noppenberger, J. (2007) Avian influenza: A review. American Journal of Health‐System Pharmacy, 64(2), 149–165.
Thompson, W. W., Comanor, L., & Shay, D. K. (2006). Epidemiology of seasonal influenza: Use of surveillance data and statistical models to estimate the burden of disease.
Journal of Infectious Diseases, 194, S82–S91.
Friday, February 25, 2011
What MCH Policy Means to the Mother in Me
Immunizations, breastfeeding, childcare, contraception, child abuse, maternal death rates, infant mortality rates… there are so many topics that pique and enhance my interest that I often feel conflicted to reflect upon just one. While the following discourse may seem entirely fragmented and tangential, the floodgate of concern and simultaneous enlightenment that I have experienced as a mother among mothers encouraged this...
I sometimes hesitate to continue the discussion of vaccines, but it highlights an underlying issue that I want to address. If such a basic tenet of public health is currently met with trepidation and often times outright disdain, how do we as a society and a global health community effectively address other matters (in essence, move on to current issues) with the gusto and perseverance that created our public health foundation? All health programs hail immunizations as the “sine qua non of a personal preventive heath intervention” and our health policy echoes the sentiment. However, our fiscal policy and subsequent funding offers a muddier view. Our state government covers the cost of certain vaccinations uniformly while others are left to insurers, Medicaid, or patients. Perhaps, if the entire cost of administering immunizations was covered by our municipal and federal governments and a standard method of distribution was adopted, some of the controversy would diminish. I understand why parents are wary of ingredients in the vaccines, the number of vaccines, and over enthusiastic physicians. During an interview with Dr. XXX, he said some other physicians were reluctant to use combined vaccinations as they are able to charge an administration fee per injection. Such knowledge is discouraging to say the least. And yet, it seems that our healthcare system is on a proverbial slippery slope and the controversy over childhood immunizations are setting us apart even further and distracting us from the issues of lack of universal healthcare, disparities in access, an overly wrought healthcare system, an aging populous, a dependent global health community, etc.
At times policy has preceded the public outcry for social change. Although my examples relate to environmental policy change regarding Carter’s Corporate Average Fuel Economy mandates and Nixon’s National Maximum Speed Law of 55 MPH to save gasoline, they illustrate how policy can change our social norms. Transitioning thrugh present day, as our society currently stands, the structural and supportive mechanisms for adequate maternal and childcare are benign. My example relates to breastfeeding. I know of no working mother who continued to breastfeed if she returned to work outside the home prior to her child’s first birthday. The majority of working women do not have the financial means to spend a year at home. While the benefits to breastfeeding are readily acknowledged, the obstacles are so very numerous that they boggle the imagination. One must be emotionally, physically, financially, and familially encouraged and supported into such a “natural” decision. Our American society puts such a financial burden on the family to generate two incomes regardless of socio-economic stratus that the decision to breastfeed is one of several components of a healthy childhood that is routinely lost. Advances do continue to be made as legislation is catching up at an achingly slow pace- there is breastfeeding in public places, federal buildings, workplace mandates regarding time to express milk and or breastfeed, exemptions from jury duty- all on the state legislative level and to varying degrees. If I breastfed in 30 out of the 50 states I could be cited for indecent exposure because I am not expressly protected. That is entirely bizarre. Perhaps these other 30 states, like most countries in the world, take breastfeeding so for granted that legislation is moot. These states may believe that breastfeeding truly is the natural and more importantly the normal way to feed an infant. Or perhaps I am just wishful thinking. I am proud of the efforts that Hawai′i has made to make breastfeeding more acceptable. The following is for reference regarding Hawaii’s Statutes:
Hawaii Rev. Stat. § 367-3 (1999) requires the Hawaii Civil Rights Commission to collect, assemble, and publish data concerning instances of discrimination involving breastfeeding or expressing breast milk in the workplace. Prohibits employers to forbid an employee from expressing breast milk during any meal period or other break period. (HB 266)
Hawaii Rev. Stat. § 378-2 (1999) provides that it is unlawful discriminatory practice for any employer or labor organization to refuse to hire or employ, or to bar or discharge from employment, or withhold pay, demote, or penalize a lactating employee because an employee breastfeeds or expresses milk at the workplace. (HB 2774)
Hawaii Rev. Stat. § 489.21 and 489-22 provides that it is a discriminatory practice to deny, or attempt to deny, the full and equal enjoyment of the goods, services, facilities, privilege, advantages, and accommodations of a place of public accommodations to a woman because she is breast feeding a child.
Even Emily Post’s etiquette book states that breastfeeding is something to be done in private. While I acknowledge that she’s hardly the standard for maternal and childcare health, that is exactly why the book should probably never have touched upon the subject. It seems that the stigma relating to breastfeeding is perpetuated in our society with a saddening deliberation.
Several years ago there were public service announcements done on breastfeeding during the National Breastfeeding Awareness Campaign that were pulled from being aired due to the AAP protesting the negative message about not breastfeeding children. The Campaign fired back saying that was the point of the ads. They were nonetheless never shown amid the controversy and heavy involvement by lobbyists on behalf Johnson & Johnson and several formula companies. When I saw the 60 minutes expose on it, I was dismayed by both sides. The following question came to mind; how can we make a woman feel guilty about not breastfeeding while simultaneously not giving her the support to do so? I read a Time article on how women were bringing their babies to work and felt encouraged that although our legislative policy may be archaic, our business ethic was shifting towards a more enlightened and caring consensus. http://www.time.com/time/magazine/article/0,9171,1699879,00.html These are among the more privileged of our society and the social injustice of the breastfeeding of a child being a luxury is palpable.
I was genuinely blessed to have grown up in the developing world- in India, Somalia, Kenya, Bangladesh, and Thailand. However, it created a presumption that I held that declining health status was a direct result of poverty and ignorance. Being also privileged to live in Hawai′i for the past fifteen years, I realize that it is just not so. There are so many determinants to health, and even more numerous facets to maternal and childcare health specifically, that need to be addressed. Health is incredibly nuanced, as is the policy framework used to describe and maintain it. For example, even the term infant mortality can mean several things depending on geographic definitions and usage. I had once (quite naively) presumed that this universal indicator would have broad and systematic usage. It is indicative of how subtle differences in diction can alter policy outcomes and participation.
I sometimes hesitate to continue the discussion of vaccines, but it highlights an underlying issue that I want to address. If such a basic tenet of public health is currently met with trepidation and often times outright disdain, how do we as a society and a global health community effectively address other matters (in essence, move on to current issues) with the gusto and perseverance that created our public health foundation? All health programs hail immunizations as the “sine qua non of a personal preventive heath intervention” and our health policy echoes the sentiment. However, our fiscal policy and subsequent funding offers a muddier view. Our state government covers the cost of certain vaccinations uniformly while others are left to insurers, Medicaid, or patients. Perhaps, if the entire cost of administering immunizations was covered by our municipal and federal governments and a standard method of distribution was adopted, some of the controversy would diminish. I understand why parents are wary of ingredients in the vaccines, the number of vaccines, and over enthusiastic physicians. During an interview with Dr. XXX, he said some other physicians were reluctant to use combined vaccinations as they are able to charge an administration fee per injection. Such knowledge is discouraging to say the least. And yet, it seems that our healthcare system is on a proverbial slippery slope and the controversy over childhood immunizations are setting us apart even further and distracting us from the issues of lack of universal healthcare, disparities in access, an overly wrought healthcare system, an aging populous, a dependent global health community, etc.
At times policy has preceded the public outcry for social change. Although my examples relate to environmental policy change regarding Carter’s Corporate Average Fuel Economy mandates and Nixon’s National Maximum Speed Law of 55 MPH to save gasoline, they illustrate how policy can change our social norms. Transitioning thrugh present day, as our society currently stands, the structural and supportive mechanisms for adequate maternal and childcare are benign. My example relates to breastfeeding. I know of no working mother who continued to breastfeed if she returned to work outside the home prior to her child’s first birthday. The majority of working women do not have the financial means to spend a year at home. While the benefits to breastfeeding are readily acknowledged, the obstacles are so very numerous that they boggle the imagination. One must be emotionally, physically, financially, and familially encouraged and supported into such a “natural” decision. Our American society puts such a financial burden on the family to generate two incomes regardless of socio-economic stratus that the decision to breastfeed is one of several components of a healthy childhood that is routinely lost. Advances do continue to be made as legislation is catching up at an achingly slow pace- there is breastfeeding in public places, federal buildings, workplace mandates regarding time to express milk and or breastfeed, exemptions from jury duty- all on the state legislative level and to varying degrees. If I breastfed in 30 out of the 50 states I could be cited for indecent exposure because I am not expressly protected. That is entirely bizarre. Perhaps these other 30 states, like most countries in the world, take breastfeeding so for granted that legislation is moot. These states may believe that breastfeeding truly is the natural and more importantly the normal way to feed an infant. Or perhaps I am just wishful thinking. I am proud of the efforts that Hawai′i has made to make breastfeeding more acceptable. The following is for reference regarding Hawaii’s Statutes:
Hawaii Rev. Stat. § 367-3 (1999) requires the Hawaii Civil Rights Commission to collect, assemble, and publish data concerning instances of discrimination involving breastfeeding or expressing breast milk in the workplace. Prohibits employers to forbid an employee from expressing breast milk during any meal period or other break period. (HB 266)
Hawaii Rev. Stat. § 378-2 (1999) provides that it is unlawful discriminatory practice for any employer or labor organization to refuse to hire or employ, or to bar or discharge from employment, or withhold pay, demote, or penalize a lactating employee because an employee breastfeeds or expresses milk at the workplace. (HB 2774)
Hawaii Rev. Stat. § 489.21 and 489-22 provides that it is a discriminatory practice to deny, or attempt to deny, the full and equal enjoyment of the goods, services, facilities, privilege, advantages, and accommodations of a place of public accommodations to a woman because she is breast feeding a child.
Even Emily Post’s etiquette book states that breastfeeding is something to be done in private. While I acknowledge that she’s hardly the standard for maternal and childcare health, that is exactly why the book should probably never have touched upon the subject. It seems that the stigma relating to breastfeeding is perpetuated in our society with a saddening deliberation.
Several years ago there were public service announcements done on breastfeeding during the National Breastfeeding Awareness Campaign that were pulled from being aired due to the AAP protesting the negative message about not breastfeeding children. The Campaign fired back saying that was the point of the ads. They were nonetheless never shown amid the controversy and heavy involvement by lobbyists on behalf Johnson & Johnson and several formula companies. When I saw the 60 minutes expose on it, I was dismayed by both sides. The following question came to mind; how can we make a woman feel guilty about not breastfeeding while simultaneously not giving her the support to do so? I read a Time article on how women were bringing their babies to work and felt encouraged that although our legislative policy may be archaic, our business ethic was shifting towards a more enlightened and caring consensus. http://www.time.com/time/magazine/article/0,9171,1699879,00.html These are among the more privileged of our society and the social injustice of the breastfeeding of a child being a luxury is palpable.
I was genuinely blessed to have grown up in the developing world- in India, Somalia, Kenya, Bangladesh, and Thailand. However, it created a presumption that I held that declining health status was a direct result of poverty and ignorance. Being also privileged to live in Hawai′i for the past fifteen years, I realize that it is just not so. There are so many determinants to health, and even more numerous facets to maternal and childcare health specifically, that need to be addressed. Health is incredibly nuanced, as is the policy framework used to describe and maintain it. For example, even the term infant mortality can mean several things depending on geographic definitions and usage. I had once (quite naively) presumed that this universal indicator would have broad and systematic usage. It is indicative of how subtle differences in diction can alter policy outcomes and participation.
Diabesity...devil in the details
My previous posts have heartily reinforced that human biology is an evolving and engaging process. Therefore, the argument regarding whether we know enough to use hormones in the management of diabetes and/or obesity is a complex one. My contention pertains to how well we, as a collective, utilize what knowledge we already have, whilst simultaneously researching and garnering more. I do not believe there is an additional knowledge threshold that currently needs to be obtained in order to contribute in meaningful and helpful ways in the usage of hormones to manage diabetes or obesity.
Specific to the treatment of ‘diabesity’: the combination of type 2 diabetes mellitus (T2DM) and obesity (Tharakan et.al, 2011), bariatic surgery has been deemed “the most successful treatment for this condition, causing durable loss of weight, proven reductions in cardiovascular events and overall mortality, as well as a sustained remission of diabetes in most patients” (L. Sjostrom et al., 2007). This surgical success story has highlighted several gut hormones and their capabilities in increasing insulin secretion, suppressing appetite, and delaying gastric empting, namely glucagon-like peptide-1 (GLP-1). This hormone has inspired research into new non-surgical methods of achieving significant and long-standing weight loss and reduction in diabetes (Tharakan et. al., 2011) through hormone use. The proposed utilization of this particular hormone in the treatment of diabesity illustrates how we are able to utilize knowledge regarding bariatric surgery, thoroughly analyze the mechanisms that contribute to its success, discover specific hormones that are significant, and then extrapolate them from the surgical process.
In addition, the responsibility of controlling diabetes is a multi-faceted and layered dilemma. Ultimately, diabetes is an individual health condition that’s responsibility remains with the individual. Regardless of the amount of public health promotion, medical services, and community support that is given, an individual’s health status remains their own. These services do greatly enhance an individual’s ability to care for themselves (McGill et. al., 2009) and are entirely integral to the success of diabetes control (Littenberg, et. al., 2006).
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Littenberg B., Strauss K., MacLean CD, Troy Ar. (July 2006). The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health. 27;6:198.
McGill, H.C., McMahan Ca., Gidding SS.,(January 2009). Are pediatricians responsible for prevention of adult cardiovascular disease? National Clinical Practice Cardiovasc Med. 6(1):10-11.
Sjostrom L., Narbro K Sjöström D., Karason K., Larsson B., Wedel H., Lystig T., Sullivan M., Bouchard C., Carlsson B., Bengtsson C., Dahlgren S., Gummesson A., Jacobso P., Karlsson J., Lindross A.K., Lönroth H., M.D., Näslund, T., Olbers T., Stenlöf K., Torgerson K., Ågren H., Carlsson L. (August 23, 2007) Effects of bariatric surgery on mortality in Swedish obese subjects, New England Journal of Medicine. 357, pp. 741–752
Tharakan G., Tan T, Bloom S.(January 2011) Emerging therapies in the treatment of 'diabesity': beyond GLP-1. Trends in Pharmacological Science. 32(1):8-15
Specific to the treatment of ‘diabesity’: the combination of type 2 diabetes mellitus (T2DM) and obesity (Tharakan et.al, 2011), bariatic surgery has been deemed “the most successful treatment for this condition, causing durable loss of weight, proven reductions in cardiovascular events and overall mortality, as well as a sustained remission of diabetes in most patients” (L. Sjostrom et al., 2007). This surgical success story has highlighted several gut hormones and their capabilities in increasing insulin secretion, suppressing appetite, and delaying gastric empting, namely glucagon-like peptide-1 (GLP-1). This hormone has inspired research into new non-surgical methods of achieving significant and long-standing weight loss and reduction in diabetes (Tharakan et. al., 2011) through hormone use. The proposed utilization of this particular hormone in the treatment of diabesity illustrates how we are able to utilize knowledge regarding bariatric surgery, thoroughly analyze the mechanisms that contribute to its success, discover specific hormones that are significant, and then extrapolate them from the surgical process.
In addition, the responsibility of controlling diabetes is a multi-faceted and layered dilemma. Ultimately, diabetes is an individual health condition that’s responsibility remains with the individual. Regardless of the amount of public health promotion, medical services, and community support that is given, an individual’s health status remains their own. These services do greatly enhance an individual’s ability to care for themselves (McGill et. al., 2009) and are entirely integral to the success of diabetes control (Littenberg, et. al., 2006).
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Littenberg B., Strauss K., MacLean CD, Troy Ar. (July 2006). The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health. 27;6:198.
McGill, H.C., McMahan Ca., Gidding SS.,(January 2009). Are pediatricians responsible for prevention of adult cardiovascular disease? National Clinical Practice Cardiovasc Med. 6(1):10-11.
Sjostrom L., Narbro K Sjöström D., Karason K., Larsson B., Wedel H., Lystig T., Sullivan M., Bouchard C., Carlsson B., Bengtsson C., Dahlgren S., Gummesson A., Jacobso P., Karlsson J., Lindross A.K., Lönroth H., M.D., Näslund, T., Olbers T., Stenlöf K., Torgerson K., Ågren H., Carlsson L. (August 23, 2007) Effects of bariatric surgery on mortality in Swedish obese subjects, New England Journal of Medicine. 357, pp. 741–752
Tharakan G., Tan T, Bloom S.(January 2011) Emerging therapies in the treatment of 'diabesity': beyond GLP-1. Trends in Pharmacological Science. 32(1):8-15
I love strawberry flavored Omnicef.
Omnicef is my favorite antibiotic. Generically known as cefdinir, it tastes great. While I am sure not too many of you taste all the medications you give your children, I do. Me and prednisone do not mix. It is yeech! I should not have such extensive knowledge, but as a self proscribed drug-seeking mother, I had always presumed that if my children were sick enough that it warranted a trip to the doctor's office, they had better give them (or me) something. What a silly mother I am...
The unique qualities and virulency of bacterial pathogens enable the mechanisms through which they cause disease and develop antibiotic resistance. Bacterial pathogens are invasive. Their ability to invade tissues through colonization, invasins, and bypass or overcome defense mechanism relate their pathogenicity and dynamic ability to mutate (Johnson, 2010). This mutability directly develops their resistance to antibiotics. Bateria become resistance via two main exposures, through medicinal antibiotic use, and through agricultural antibiotic use. Medicinal antibiotic resistance is primarily developed through overprescription of antibiotics, incomplete usage by patients, and improper hygiene by medical personnel (Girou et. al., 2006). This is coupled by antibiotic resistance developed though agricultural use for food-production animals. The antibiotic resistant bacteria are spread via ingestion and/or human to animal contact.
The specific biological pathways to antibiotic resistance are primed by these two main exposures. Resistance is a result of horizontal gene transfer and point mutations caused by drug inactivation or modification, alteration of the binding site or pathway, and reduced drug accumulation by decreasing permeability or increasing efflux. Simple measures can be taken to prevent the spread of disease and subsequent reliance on antibiotics such as frequent hand washing (Girou et.al., 2006). However, in the event of illness and disease, antibiotics are still utilized, readily prescribed by physicians, and desired by caregivers. I can personally attest to readily “encouraging” the prescription for my children. Yet, a WHO study in Pakistan (Hazir et. al., 2010) documented 7.2% and 8.3% therapy failure rates among non-severe pneumonia pediatric patients. The different in rates was not statistically significant, concluding that the clinical outcome was no different among the participants. Utilizing this information to educate community members would undoubtedly alleviate some pressure upon physicians who hesitate to educate their patients about the dangers of antibiotic misuse.
Girou, E., Legrand, P., Soing- Altrach, S., Lemire, A., Poulain, C, Allaire A, Tkoub-Scheirlinck, L, Chai, SH, Dupeyron, C, Loche, CM.(October 2006)Association between hand hygiene compliance and methicillin-resistant Staphylococcus aureus prevalence in a French rehabilitation hospital. Infection Control Hospital Epidemiology, 27, 10, 1128-1130. doi: 10.1086/507967.
Hazir, T., Nisar, Y., Abbasi, S., Ashraf, Y., Khurshid, J., Tariq, P., Asghar, R., Murtaza, A., Massod, T., Maqbool, S. (February 2010) Comparison of Oral Amoxicillin with Placebo for the Treatment of World Health Organization- Defined Nonserve pneumonia in Children aged 2-59 months: A multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clinical Infectious Diseases, 52, 3, 293-300.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
The unique qualities and virulency of bacterial pathogens enable the mechanisms through which they cause disease and develop antibiotic resistance. Bacterial pathogens are invasive. Their ability to invade tissues through colonization, invasins, and bypass or overcome defense mechanism relate their pathogenicity and dynamic ability to mutate (Johnson, 2010). This mutability directly develops their resistance to antibiotics. Bateria become resistance via two main exposures, through medicinal antibiotic use, and through agricultural antibiotic use. Medicinal antibiotic resistance is primarily developed through overprescription of antibiotics, incomplete usage by patients, and improper hygiene by medical personnel (Girou et. al., 2006). This is coupled by antibiotic resistance developed though agricultural use for food-production animals. The antibiotic resistant bacteria are spread via ingestion and/or human to animal contact.
The specific biological pathways to antibiotic resistance are primed by these two main exposures. Resistance is a result of horizontal gene transfer and point mutations caused by drug inactivation or modification, alteration of the binding site or pathway, and reduced drug accumulation by decreasing permeability or increasing efflux. Simple measures can be taken to prevent the spread of disease and subsequent reliance on antibiotics such as frequent hand washing (Girou et.al., 2006). However, in the event of illness and disease, antibiotics are still utilized, readily prescribed by physicians, and desired by caregivers. I can personally attest to readily “encouraging” the prescription for my children. Yet, a WHO study in Pakistan (Hazir et. al., 2010) documented 7.2% and 8.3% therapy failure rates among non-severe pneumonia pediatric patients. The different in rates was not statistically significant, concluding that the clinical outcome was no different among the participants. Utilizing this information to educate community members would undoubtedly alleviate some pressure upon physicians who hesitate to educate their patients about the dangers of antibiotic misuse.
Girou, E., Legrand, P., Soing- Altrach, S., Lemire, A., Poulain, C, Allaire A, Tkoub-Scheirlinck, L, Chai, SH, Dupeyron, C, Loche, CM.(October 2006)Association between hand hygiene compliance and methicillin-resistant Staphylococcus aureus prevalence in a French rehabilitation hospital. Infection Control Hospital Epidemiology, 27, 10, 1128-1130. doi: 10.1086/507967.
Hazir, T., Nisar, Y., Abbasi, S., Ashraf, Y., Khurshid, J., Tariq, P., Asghar, R., Murtaza, A., Massod, T., Maqbool, S. (February 2010) Comparison of Oral Amoxicillin with Placebo for the Treatment of World Health Organization- Defined Nonserve pneumonia in Children aged 2-59 months: A multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clinical Infectious Diseases, 52, 3, 293-300.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Thursday, February 24, 2011
I have never been skinny...
except mentally while pregnant. I will explain, gaining a whopping 60 pounds during my first pregnancy I whole-heartedly convinced myself that Kate Moss was a model of MY prepregnancy self. Hmmm...delusions aside, I know it it hard to keep and maintain one's health. The following is my attempt at finding additional motivation.
Nutrition, Obesity, and Atherosclerotic Cardiovascular Disease: a Trifecta of Energy Homeostasis
The prevalence of obesity has propelled its causation and treatment to the forefront of medical vernacular and concern. This concern pertains to obesity’s contribution to numerous other disease states and comorbidities. Specifically concerning is its association in accelerating atherosclerosis and cardiovascular death. Atherosclerosis is characterized by the deposition of plaque in the form of fatty substances such as cholesterol in the innermost layer of the arterial wall. Such an association is demon
strated through the increase in hypertension, diabetes, and dyslipidemia. The role of nutrition in diminishing obesity and subsequently the associated atherosclerosis is ever increasing as non-surgical and preventative methods are emphasized. While numerous research studies are examining this relationship, the following review highlights three studies that researched the role of specific nutrient factors in contributing and controlling obesity and atherosclerosis.
Biological Basis
Energy homeostasis pertains to the ability to maintain a stable biological state regardless of adjustments in nutrition or environmental changes. The biological mechanisms that contribute to this physiological regulation consist of organ systems, organs, hormones, microbes, molecules, and cells. These mechanisms function by integration of intake and expenditure and subsequent (re)allocation of energy. For example, during periods of energy deficiency, the brain’s neuronal pathways cause appetite to increase while metabolic rate declines (Flier et.al, 2007). . The endocrine and nervous system also regulate digestion and energy extraction. This combination causes efficient recovery of lost weight when access to energy is restored. This energy storage is of vital importance as 78% of a body’s energy stores is in the form of fats (Johnson, 2010). However, maladaptive responses to this relationship caused by excess storage due to excess energy consumption results in obesity.
This excess energy consumption pertains to malnutrition, defined by an excess or an deficiency of nutrients (Johnson, 2010). The subsequent connection between nutrition, obesity, and atherosclerotic cardiovascular disease is a result of mounting evidence relating how nutrition affects obesity levels and how obesity affects atherosclerosis. The research articles that are reviewed in the following discourse identified the nutritional component as integral to obesity treatment and prevention.
Research Findings
Research by Haiming et. al. (2008), in the identification of lipokine, documented an increase in lipogenesis enabled resistance in adipose tissue to the “systemic effects of dietary lipid exposure” (Haiming et. al., 2008). This resistance was documented through the tissue lipid profiles of mice. These mice were deficient in specific fatty acid binding proteins (FABPs) that resulted in significant improvements in their resistance levels. Those deficient in FABP2 had improved insulin sensitivity. Those with combined deficiency in both FABP4 and FABP5 had “profound” systemic metabolic regulation and were resistance to atherosclerosis and obesity (Haiming et. al., 2008).
Further analysis by Valavanis et. al. (2010) sought to identify obesity as a cardiovascular disease risk factor. Researched initially examined 24 genetic variants and 38 nutritional variants to study the etiology of obesity through a dataset of 2,341 participants. Two artificial neuron networks (ANNs) were used to analyze data pertaining to the participants’ risk factors in accordance to their BMI. Eighteen nutritional variants were identified as components of obesity as a risk factor. The primary nutritional factor was determined as cholesterol-intake in food. Additional factors include vitamin A-total intake, omega 3-intake in supplements, and vitamin B12- intake in food.
Stepien et al. (2011) sought to evaluate the high protein diet (HPD) as a strategy against obesity. Eighty Wistar rats were studied in varying dietary feeding modes and mRNA levels were measured in the liver, adipose tissues, kidneys, and muscles. Energy expenditure was measured by calorimetry. Significant results in organs were only observed in the liver where decreased mRNA encoding glycolysis and lipogenesis enzymes and increased mRNA encoding gluconeogenesis enzyme lowering and stabilization occurred. This was coupled by calorimetry that resulted in a reduction in glucose oxidation and stable fat oxidation.
Public Health Application
Within a public health context, Valavanis’ 18 nutritional variants and Stepien’s high protein diet have a greater applicability than Haiming’s lipokine identification. This applicability pertains to the incorporation of nutritional factors such as vitamin A or omega-3 supplementation into obesity treatment and prevention that is not readily adhered in regards to removal of FABPs. For example, nutritional program implementation could utilize Valavanis and Haiming’s data to create possible weight loss or management programs that are high in protein, low in cholesterol, high in vitamin A and B12, and encourage supplementation of omega-3s and vitamin A. Prevention programs utilizing existing school lunch programs, corporate meal providers, senior meal centers, etc. could incorporate these dietary guidelines. Undoubtedly, current guidelines would be hard to change based on data extrapolated from mice and rats, but pilot test programs within these existing providers may be effective. The current obesity pandemic warrants such efforts in research and implementation.
References
Anderson P. (December 2008) Reducing overweight and obesity: closing the gap between primary care and public health. Family Practicec;25 Suppl 1:i10-6.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Disease, Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Flier, J.S., & Maratos-Flier, E. (2007). What fuels fat. Scientific American, 297, 72–81.
Getz, G. S., & Reardon, C. A. (2007). Nutrition and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 27, 2499–2506.
Haiming, C., Gerhold, K., Mayers, J., Wiest, M., Watkins, S., and Hotamisligil, G. (September 2008) Identification of a Lipokine, a Lipid Hormone Linking Adipose Tissue to Systemic Meatbolism. Cell , 134, 6, 933-944. doi:10.106/j.cell.2008.07.048
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Katagiri, H., Yamada, T., & Oka, Y. (2007). Adiposity and cardiovascular disorders disturbance of the regulatory system consisting of humoral and neuronal signals. Circulation Research, 101, 27–39.
Kersh R, Morone JA. (2005).Obesity, courts, and the new politics of public health. J Health Polit Policy Law,30(5):839-68.
Lopaschuk, G. D., Folmes, C. D. L., & Stanley, W. C. (2007). Cardiac energy metabolism in obesity. Circulation Research, 101, 335–347.
McGavock, J. M., Victor, R. G., Unger, R. H., & Szczepaniak, L. S. (2006). Adiposity of the heart, revisited. Annals of Internal Medicine, 144, 517–524.
Semenkovich, C. F. (2006). Insulin resistance and atherosclerosis. Journal of Clinical Investigation, 116, 1813–1822.
Stepien, M., Gaudichon, C., Fromentin, G., Even, P., Tome, D., Azzout- Marniche, D. (February 2011) Plos One, 6, 2.
Valavanis, I., Mougiakakou, St., Grimaldi, K., Nikita, K. (2010) A multifactorial analysis of obesity as CVD risk factor: Use of neural network based methods in a nutrigenetics context. Bio Med Central Bioinformatics 11, 453.
Nutrition, Obesity, and Atherosclerotic Cardiovascular Disease: a Trifecta of Energy Homeostasis
The prevalence of obesity has propelled its causation and treatment to the forefront of medical vernacular and concern. This concern pertains to obesity’s contribution to numerous other disease states and comorbidities. Specifically concerning is its association in accelerating atherosclerosis and cardiovascular death. Atherosclerosis is characterized by the deposition of plaque in the form of fatty substances such as cholesterol in the innermost layer of the arterial wall. Such an association is demon
strated through the increase in hypertension, diabetes, and dyslipidemia. The role of nutrition in diminishing obesity and subsequently the associated atherosclerosis is ever increasing as non-surgical and preventative methods are emphasized. While numerous research studies are examining this relationship, the following review highlights three studies that researched the role of specific nutrient factors in contributing and controlling obesity and atherosclerosis.
Biological Basis
Energy homeostasis pertains to the ability to maintain a stable biological state regardless of adjustments in nutrition or environmental changes. The biological mechanisms that contribute to this physiological regulation consist of organ systems, organs, hormones, microbes, molecules, and cells. These mechanisms function by integration of intake and expenditure and subsequent (re)allocation of energy. For example, during periods of energy deficiency, the brain’s neuronal pathways cause appetite to increase while metabolic rate declines (Flier et.al, 2007). . The endocrine and nervous system also regulate digestion and energy extraction. This combination causes efficient recovery of lost weight when access to energy is restored. This energy storage is of vital importance as 78% of a body’s energy stores is in the form of fats (Johnson, 2010). However, maladaptive responses to this relationship caused by excess storage due to excess energy consumption results in obesity.
This excess energy consumption pertains to malnutrition, defined by an excess or an deficiency of nutrients (Johnson, 2010). The subsequent connection between nutrition, obesity, and atherosclerotic cardiovascular disease is a result of mounting evidence relating how nutrition affects obesity levels and how obesity affects atherosclerosis. The research articles that are reviewed in the following discourse identified the nutritional component as integral to obesity treatment and prevention.
Research Findings
Research by Haiming et. al. (2008), in the identification of lipokine, documented an increase in lipogenesis enabled resistance in adipose tissue to the “systemic effects of dietary lipid exposure” (Haiming et. al., 2008). This resistance was documented through the tissue lipid profiles of mice. These mice were deficient in specific fatty acid binding proteins (FABPs) that resulted in significant improvements in their resistance levels. Those deficient in FABP2 had improved insulin sensitivity. Those with combined deficiency in both FABP4 and FABP5 had “profound” systemic metabolic regulation and were resistance to atherosclerosis and obesity (Haiming et. al., 2008).
Further analysis by Valavanis et. al. (2010) sought to identify obesity as a cardiovascular disease risk factor. Researched initially examined 24 genetic variants and 38 nutritional variants to study the etiology of obesity through a dataset of 2,341 participants. Two artificial neuron networks (ANNs) were used to analyze data pertaining to the participants’ risk factors in accordance to their BMI. Eighteen nutritional variants were identified as components of obesity as a risk factor. The primary nutritional factor was determined as cholesterol-intake in food. Additional factors include vitamin A-total intake, omega 3-intake in supplements, and vitamin B12- intake in food.
Stepien et al. (2011) sought to evaluate the high protein diet (HPD) as a strategy against obesity. Eighty Wistar rats were studied in varying dietary feeding modes and mRNA levels were measured in the liver, adipose tissues, kidneys, and muscles. Energy expenditure was measured by calorimetry. Significant results in organs were only observed in the liver where decreased mRNA encoding glycolysis and lipogenesis enzymes and increased mRNA encoding gluconeogenesis enzyme lowering and stabilization occurred. This was coupled by calorimetry that resulted in a reduction in glucose oxidation and stable fat oxidation.
Public Health Application
Within a public health context, Valavanis’ 18 nutritional variants and Stepien’s high protein diet have a greater applicability than Haiming’s lipokine identification. This applicability pertains to the incorporation of nutritional factors such as vitamin A or omega-3 supplementation into obesity treatment and prevention that is not readily adhered in regards to removal of FABPs. For example, nutritional program implementation could utilize Valavanis and Haiming’s data to create possible weight loss or management programs that are high in protein, low in cholesterol, high in vitamin A and B12, and encourage supplementation of omega-3s and vitamin A. Prevention programs utilizing existing school lunch programs, corporate meal providers, senior meal centers, etc. could incorporate these dietary guidelines. Undoubtedly, current guidelines would be hard to change based on data extrapolated from mice and rats, but pilot test programs within these existing providers may be effective. The current obesity pandemic warrants such efforts in research and implementation.
References
Anderson P. (December 2008) Reducing overweight and obesity: closing the gap between primary care and public health. Family Practicec;25 Suppl 1:i10-6.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Disease, Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Flier, J.S., & Maratos-Flier, E. (2007). What fuels fat. Scientific American, 297, 72–81.
Getz, G. S., & Reardon, C. A. (2007). Nutrition and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 27, 2499–2506.
Haiming, C., Gerhold, K., Mayers, J., Wiest, M., Watkins, S., and Hotamisligil, G. (September 2008) Identification of a Lipokine, a Lipid Hormone Linking Adipose Tissue to Systemic Meatbolism. Cell , 134, 6, 933-944. doi:10.106/j.cell.2008.07.048
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Katagiri, H., Yamada, T., & Oka, Y. (2007). Adiposity and cardiovascular disorders disturbance of the regulatory system consisting of humoral and neuronal signals. Circulation Research, 101, 27–39.
Kersh R, Morone JA. (2005).Obesity, courts, and the new politics of public health. J Health Polit Policy Law,30(5):839-68.
Lopaschuk, G. D., Folmes, C. D. L., & Stanley, W. C. (2007). Cardiac energy metabolism in obesity. Circulation Research, 101, 335–347.
McGavock, J. M., Victor, R. G., Unger, R. H., & Szczepaniak, L. S. (2006). Adiposity of the heart, revisited. Annals of Internal Medicine, 144, 517–524.
Semenkovich, C. F. (2006). Insulin resistance and atherosclerosis. Journal of Clinical Investigation, 116, 1813–1822.
Stepien, M., Gaudichon, C., Fromentin, G., Even, P., Tome, D., Azzout- Marniche, D. (February 2011) Plos One, 6, 2.
Valavanis, I., Mougiakakou, St., Grimaldi, K., Nikita, K. (2010) A multifactorial analysis of obesity as CVD risk factor: Use of neural network based methods in a nutrigenetics context. Bio Med Central Bioinformatics 11, 453.
Thursday, February 3, 2011
Warning Labels
The 300 million (Siegle, 2008) dietary supplement users are unwitting participants in quite possibly the largest randomized control study regarding the safety of dietary supplements. This de facto participation is made evident by the 37 L-tryptophan users whose deaths in 1989 highlighted a dose-response relationship that resulted in the recognition of 60,000 global eosinophilia-myalgia syndrome cases (Rieber et al., 2010). This is continuously reinforced as supplement users are validating their dissatisfaction with conventional treatments, their desire to control their own health care, and agreement with the philosophy of prevention and ideas of alternative therapies (Astin, 1998) while risking exposure to chemicals, contaminants, and toxins (van Breemen et al., 2008). The rapid development, production, and distribution of dietary supplements (van Breemen et al., 2008) fuels this desire and contrasts the lengthy process of prescription drug development, manufacture, testing, and FDA review and approval and expense (USFDA, 2007) that results in conventional prescription drugs. In addition, supplement users are simultaneously confronted with over-the-counter and prescription drug recalls of Tylenol, Benadryl, Meridia, Multaq, Paxil, Propofol (USFDA, 2011) and documentation of their debilitating side-effects that misguidedly reinforces the concept of “natural” as safer. This precarious cycle is aptly illustrated by the progression of willow bark as a traditional and “natural” analgesic and antiinflammatory drug, the extraction of salicylic acid from the willow bark, and chemical synthesis into acetylsalicylic acid (aspirin). Subsequently, aspirin is implicated in case-control studies as contributing to Reye’s syndrome (Glasgow, 2006). Thus, depicting that conventional medications also carry risks associated with use and safety issues are prevalent among all types of ingestibles. The contentious issue remains as the impression that dietary supplements are safer has not been adequately dispelled. Perhaps, a more extensive warning label informing the consumer of their automatic enrollment in a supplement control study would adequately impress upon the possibility of unknown, yet potentially hazardous side-effects.
Astin, JA. (1998) Why patients use alternative medicine: Results of a national study. JAMA 279, 1548-1553.
Glasgow JF. (2006) Reye’s syndrome, the case for a causal link with aspirin. Drug Safety 29,12, 1111-1121.
Belohradsky BH. (2010) AHR activation by tryptophan—Pathogenic hallmark of Th17-mediated inflammation in eosinophilic fasciitis, eosinophilia–myalgia-syndrome and toxic oil syndrome. Immunology Letters 128, 2, 154-155.
Siegle, L. (2008, February 17). How Healthy are Dietary Supplements?. The Observer. http://observer.guardian.co.uk.
U.S. Food & Drug Administration. (2007) CDER 2007 Update: Improving Public Health Through Human Drugs. Retrieved January 19, 2010, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess
U.S. Food & Drug Administration. (2011) Enforcement Reports. Retrieved January 19, 2010 from http://www.fda.gov/Safety/Recalls/EnforcementReports/default.htm
Van Breemen, R.B., Fong, H.H., & Farnsworth, N.R. (2008) Ensuring the Safety of botanical dietary supplements. The American Journal of Clinical Nutrition 87, 2, 509S-5013S
Astin, JA. (1998) Why patients use alternative medicine: Results of a national study. JAMA 279, 1548-1553.
Glasgow JF. (2006) Reye’s syndrome, the case for a causal link with aspirin. Drug Safety 29,12, 1111-1121.
Belohradsky BH. (2010) AHR activation by tryptophan—Pathogenic hallmark of Th17-mediated inflammation in eosinophilic fasciitis, eosinophilia–myalgia-syndrome and toxic oil syndrome. Immunology Letters 128, 2, 154-155.
Siegle, L. (2008, February 17). How Healthy are Dietary Supplements?. The Observer. http://observer.guardian.co.uk.
U.S. Food & Drug Administration. (2007) CDER 2007 Update: Improving Public Health Through Human Drugs. Retrieved January 19, 2010, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess
U.S. Food & Drug Administration. (2011) Enforcement Reports. Retrieved January 19, 2010 from http://www.fda.gov/Safety/Recalls/EnforcementReports/default.htm
Van Breemen, R.B., Fong, H.H., & Farnsworth, N.R. (2008) Ensuring the Safety of botanical dietary supplements. The American Journal of Clinical Nutrition 87, 2, 509S-5013S
The skinny on skin
The skin is the external tissue of all vertebrates. In the human body, it is considered the largest organ, consisting of approximately 15% of a body’s weight. This size relates its dynamic nature and the significance of the skin in its multiple functions as a physical barrier and sensory organ. These barrier functions pertain to environmental elements, UV radiation, retention and expulsion of water providing for hydration and thermoregulation, and protection from organisms and physical injury.
The skin consists of three structural layers that enable these multiple functions, the epidermis, the dermis, and the subcutis. The epidermis is the outer most layer that in itself consists of five layers of stratified squamous epithelium, the basal, spinosum, granulosum, licidum, and corneum. The dermis underlies the epidermis and serves as the connective tissue between it and the subcutis. This tissue contains the hair roots, sweat glands, nervous cells, blood vessels, and lymph vessels. The innermost layer, the subcutis, consists of loose connective tissue and fat.
Tinea versicolor or pityriasis versicolor is a common skin infection in tropical climates such as Hawai'i. Colloquially referred to as Haole rot, kane, or tane, it is caused by the Malassezia yeast and is characterized by whitish discs on the upper torso. The research study I examined compared the clinical response between two treatments for the infection, a systemic fluconazole pill and a topical clotrimazole cream. The results determined that the clotrimazole cream had greater efficacy in the 2nd and 4th week resolution interval (Dehghan et. al., 2010). The fluconazole pill had greater efficacy in the 12th week resolution interval and had a decreased rate of reoccurrence. The study concluded that the clotrimazole cream is more effective in treatment and the fluconazole pill is more effective in preventing recurrence.
Dehghan, M., Akbari, N., Alborzi, N., Sadani, S., Keshtkar, A. (2010) Single dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. Journal of Dermatology, 37, 699-702.
Gawkrodger DJ. (2002). Dermatology, An Illustrated Colour Text. 3rd ed. Edinburgh: Churchill Livingstone.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
The skin consists of three structural layers that enable these multiple functions, the epidermis, the dermis, and the subcutis. The epidermis is the outer most layer that in itself consists of five layers of stratified squamous epithelium, the basal, spinosum, granulosum, licidum, and corneum. The dermis underlies the epidermis and serves as the connective tissue between it and the subcutis. This tissue contains the hair roots, sweat glands, nervous cells, blood vessels, and lymph vessels. The innermost layer, the subcutis, consists of loose connective tissue and fat.
Tinea versicolor or pityriasis versicolor is a common skin infection in tropical climates such as Hawai'i. Colloquially referred to as Haole rot, kane, or tane, it is caused by the Malassezia yeast and is characterized by whitish discs on the upper torso. The research study I examined compared the clinical response between two treatments for the infection, a systemic fluconazole pill and a topical clotrimazole cream. The results determined that the clotrimazole cream had greater efficacy in the 2nd and 4th week resolution interval (Dehghan et. al., 2010). The fluconazole pill had greater efficacy in the 12th week resolution interval and had a decreased rate of reoccurrence. The study concluded that the clotrimazole cream is more effective in treatment and the fluconazole pill is more effective in preventing recurrence.
Dehghan, M., Akbari, N., Alborzi, N., Sadani, S., Keshtkar, A. (2010) Single dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. Journal of Dermatology, 37, 699-702.
Gawkrodger DJ. (2002). Dermatology, An Illustrated Colour Text. 3rd ed. Edinburgh: Churchill Livingstone.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Walk it off , walk it off
Osteoporosis, a condition caused by the imbalance of bone resorption and bone formation, is a debilitating disease that causes bone deterioration (Johnson, 2010). Considered by some as a preventable disease and by others a genetic disorder that exhibits through aging (Livshits, 2005), all herald the importance of diet and exercise in the prevention or onset delay of osteoporosis. Specifically identified are the incorporation of 1,000 mg of calcium per day, vitamin D (UC-Davis, 2010), weight-bearing exercise such as walking 30 minutes per day, and weight-lifting (Bergmann, 2010). However, the challenge remains in patient participation and follow-through. It is especially challenging in the establishment of fitness routines and diet among those previously sedentary and malnourished, as prevention is significantly enhanced by the duration of fitness and diet prior to onset (Lv, 2011).
Perhaps, this challenge can be addressed by more effective osteoporosis health educational programs. Specific genotypes have been linked to adult onset of osteoporosis (Livshits, 2005) that allow for targeted educational programs (Lv, 2011). This targeting seems essential, as concentrating on specific groups of people, such as an ethno-cultural group, that have higher prevalence of a disease can encourage participation and awareness. Similar to the association of sickle-cell anemia affecting African-Americans, breast cancer affecting women, osteoporosis as an Asian-American disease is generating concentrated efforts of developing nutritional, pharmaceutical, and lifestyle options and programs. While these efforts are currently wide-spread, the concentration of research among this affected population allows for greater determinations to be made regarding pharmaceutical efficacy and program evaluation.
Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. (2010, December 20)Loading and skeletal development and maintenance. Journal Osteoporos, 2011, 786752.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Livshits, G. (2005 February) Genetic epidemiology of skeletal system aging in apparently healthy human population. Mech Ageing Dev.;126(2):269-79.
Lv, N, Brown, JL., (2011, January) Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. Journal of American Diet Association.111(1):143-9.
University of California-Davis- Health System (2010, January 15). Benefits of calcium and vitamin D in preventing fractures confirmed. ScienceDaily. Retrieved January 31, 2011 from http://www.sciencedaily.com /releases/2010/01/100114143325.htm
Perhaps, this challenge can be addressed by more effective osteoporosis health educational programs. Specific genotypes have been linked to adult onset of osteoporosis (Livshits, 2005) that allow for targeted educational programs (Lv, 2011). This targeting seems essential, as concentrating on specific groups of people, such as an ethno-cultural group, that have higher prevalence of a disease can encourage participation and awareness. Similar to the association of sickle-cell anemia affecting African-Americans, breast cancer affecting women, osteoporosis as an Asian-American disease is generating concentrated efforts of developing nutritional, pharmaceutical, and lifestyle options and programs. While these efforts are currently wide-spread, the concentration of research among this affected population allows for greater determinations to be made regarding pharmaceutical efficacy and program evaluation.
Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. (2010, December 20)Loading and skeletal development and maintenance. Journal Osteoporos, 2011, 786752.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Livshits, G. (2005 February) Genetic epidemiology of skeletal system aging in apparently healthy human population. Mech Ageing Dev.;126(2):269-79.
Lv, N, Brown, JL., (2011, January) Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. Journal of American Diet Association.111(1):143-9.
University of California-Davis- Health System (2010, January 15). Benefits of calcium and vitamin D in preventing fractures confirmed. ScienceDaily. Retrieved January 31, 2011 from http://www.sciencedaily.com /releases/2010/01/100114143325.htm
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