Publications by authors named "Paul J Mills"

246 Publications

Global Correlations Between Chronic Inflammation and Violent Incidents: Potential Behavioral Consequences of Inflammatory Illnesses Across Socio-Demographic Levels.

Int J Gen Med 2021 12;14:6677-6691. Epub 2021 Oct 12.

Education Department, Whole Health School of Medicine and Health Sciences, Bentonville, AR, USA.

Introduction: This review explores the potential correlation between conditions associated with chronic inflammation and measures of violence across five socioeconomic subgroups. The hypothesis being that since chronic inflammation is associated with increased aggression, an extreme version of which is violence, there should be a correlation between incidents of violence and diseases with one or more inflammatory factors, without an equivalent correlation with the contrast group. An extension of this reasoning would predict a higher correlation among lower socio-demographic index (SDI) populations as a result of fewer resources to prevent either inflammatory disease or violent crime.

Methods: In order to examine this potential correlation, an analysis was made comparing rates of change in incidence between violence, inflammatory conditions, and a contrast group disease of noninflammatory nature, as determined by Pearson's correlation coefficient.

Results: In the low socio-demographic index, inflammatory conditions demonstrated 80% correlation with interpersonal violence, middle-low socio-demographic index inflammatory conditions demonstrated 60% correlation with interpersonal violence, middle socio-demographic index inflammatory conditions demonstrated 0% correlation with interpersonal violence, middle-high socio-demographic index inflammatory conditions demonstrated 60% correlation with interpersonal violence, and high socio-demographic index inflammatory conditions demonstrated 40% correlation with interpersonal violence.

Discussion: The majority of socio-demographic groups showed a significant correlation between rates of change in incidence of violence and inflammatory conditions. This correlation was not found with a similar frequency or strength in diseases not causally linked to inflammation. As predicted in the hypothesis, the highest correlations of inflammatory diseases with violence existed in the lower socio-demographic populations, supporting a link between inflammatory levels and incidences of violence.
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http://dx.doi.org/10.2147/IJGM.S324367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520436PMC
October 2021

Cell-Free Mitochondrial DNA as a Potential Biomarker for Astronauts' Health.

J Am Heart Assoc 2021 Nov 20;10(21):e022055. Epub 2021 Oct 20.

Cardiovascular Research Institute Icahn School of Medicine at Mount Sinai New York NY.

Background Space travel-associated stressors such as microgravity or radiation exposure have been reported in astronauts after short- and long-duration missions aboard the International Space Station. Despite risk mitigation strategies, adverse health effects remain a concern. Thus, there is a need to develop new diagnostic tools to facilitate early detection of physiological stress. Methods and Results We measured the levels of circulating cell-free mitochondrial DNA in blood plasma of 14 astronauts 10 days before launch, the day of landing, and 3 days after return. Our results revealed a significant increase of cell-free mitochondrial DNA in the plasma on the day of landing and 3 days after return with vast ~2 to 355-fold interastronaut variability. In addition, gene expression analysis of peripheral blood mononuclear cells revealed a significant increase in markers of inflammation, oxidative stress, and DNA damage. Conclusions Our study suggests that cell-free mitochondrial DNA abundance might be a biomarker of stress or immune response related to microgravity, radiation, and other environmental factors during space flight.
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http://dx.doi.org/10.1161/JAHA.121.022055DOI Listing
November 2021

Systemic Inflammation and Cognitive Decrements in Patients with Stage B Heart Failure.

Psychosom Med 2021 Oct 12. Epub 2021 Oct 12.

College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA Department of Psychiatry, University of California School of Medicine, San Diego, CA, USA Department of Family Medicine and Public Health, University of California School of Medicine, San Diego, CA, USA Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA Behavioral Medicine Research Center, University of Miami, Miami, Florida, USA; Department of Psychology, University of Miami, Coral Gables, Florida, USA; Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, Florida, USA Department of Medicine, University of California School of Medicine, San Diego, CA, USA Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: To investigate the role of systemic inflammation in reduced cognitive functioning in patients with early-stage heart failure (HF), while taking associations with other cardiovascular risk factors into account.

Methods: Patients with stage B HF (n = 270; mean age 66.1 ± 10.1) were examined cross-sectionally for relationships among cardiovascular disease (CVD) and psychological risk factors, c-reactive protein (CRP) and Montreal Cognitive Assessment (MoCA) scores. A subsample (n = 83), at high-risk for stage C HF (B-type natriuretic peptide (BNP) levels >65 pg/mL) were followed for 12-months for relationships between CRP levels and cognitive function.

Results: Baseline smoking (c2 = 6.33), unmarried (c2 = 12.0), hypertension (c2 = 5.72), greater body mass index (d = .45), and physical fatigue (d = .25) were related to higher CRP levels (p's < .05). Cross-sectionally, CRP levels were negatively related to MoCA scores, beyond CVD (DR2 = .022, b = -.170, p < .010) and psychological risk factors (DR2 = .016, b = .145, p < .027) and related to MCI criteria (odds ratio = 1.35, 95% CI 1.00 - 1.81, p = .046). Across 12-months, BNP high-risk patients with CRP levels ≥3 mg/L had lower MoCA scores (23.6; 95% CI 22.4 - 24.8) than patients with CRP levels <3 mg/L (25.4; 95% CI 24.4 - 26.5) (p = .024).

Conclusion: Patients with stage B HF and heightened CRP levels had greater cognitive impairment at baseline and follow-up, independent of CVD and potentially psychological risk factors. Low-grade systemic inflammation may be one mechanism involved in cognitive dysfunction at early stages of HF.
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http://dx.doi.org/10.1097/PSY.0000000000001033DOI Listing
October 2021

Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation.

J Inflamm Res 2021 22;14:4859-4876. Epub 2021 Sep 22.

Herbert Wertheim School of Public Health and Human Longevity Science, Center of Excellence for Research and Training in Integrative Health, University of California, San Diego, CA, USA.

Introduction: COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself.

Methods: Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD).

Results: The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%.

Discussion: Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.
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http://dx.doi.org/10.2147/JIR.S323356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473718PMC
September 2021

Cross-Cultural Analysis of Spiritual Bypass: A Comparison Between Spain and Honduras.

Front Psychol 2021 6;12:658739. Epub 2021 May 6.

Department of Family Medicine and Public Health, University of California, San Diego, San Diego, La Jolla, CA, United States.

Religion and spirituality (R/S) serve as coping mechanisms for circumstances that threaten people's psychological well-being. However, using R/S inappropriately to deal with difficulties and problems in daily life may include the practice of Spiritual Bypass (SB). SB refers to avoiding addressing emotional problems and trauma, rather than healing and learning from them. On the other hand, coping strategies may be determined by the cultural context. This study aims to describe the presence of SB in individuals who may have experienced stressful situations and to understand the influence of culture on SB by comparing SB in two culturally different groups. The sample consists of a total of 435 people, 262 of Honduran nationality and 173 of Spanish nationality. Both groups are approximately equivalent in age and gender. The degree of SB, stressful events, perception of social support and spiritual well-being are examined, respectively, through the Spiritual Bypass Scale, and specific items and subscales from the Social Readjustment Rating Scale, Multidimensional Scale of Perceived Social Support, and the Functional Assessment of Chronic Illness Therapy - Spiritual Wellbeing. The results showed a higher spiritual well-being and use of SB in the Honduran sample as compared to the Spanish sample, but similar social support and stressful events. Furthermore, some of the factors predicting SB were different between the two samples. While age and a greater number of R/S practices were important in both samples, for the Honduran sample the variables that best explained SB were being a Christian, having greater social support, fewer stressful events, and greater attendance at church or temple. For the Spanish sample, however, the variable that best explained SB was studying R/S texts. Therefore, SB must be understood within the culture in which it develops, since in different cultural contexts it appears to relate to differing factors. Thus, SB becomes a possible functional or dysfunctional coping strategy depending on the social context.
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http://dx.doi.org/10.3389/fpsyg.2021.658739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134675PMC
May 2021

Workshop on reproducibility in research.

J Clin Transl Sci 2020 Jun 19;4(6):562-564. Epub 2020 Jun 19.

Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.

In recent years, concern about research reproducibility has increased dramatically for scientists, funders of research, and the general public. With a view to explicitly address what is often called a reproducibility crisis and putting the focus on research being done by individual trainees, a two-hour workshop was developed and introduced into six courses at UC San Diego. Participation in the workshop resulted in a statistically significant increase in the number of different types of strategies identified by the trainees for fostering reproducibility. The findings are consistent with having increased awareness of strategies to promote reproducibility.
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http://dx.doi.org/10.1017/cts.2020.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057479PMC
June 2020

Workshop on reproducibility in research.

J Clin Transl Sci 2020 Jun 19;4(6):562-564. Epub 2020 Jun 19.

Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.

In recent years, concern about research reproducibility has increased dramatically for scientists, funders of research, and the general public. With a view to explicitly address what is often called a reproducibility crisis and putting the focus on research being done by individual trainees, a two-hour workshop was developed and introduced into six courses at UC San Diego. Participation in the workshop resulted in a statistically significant increase in the number of different types of strategies identified by the trainees for fostering reproducibility. The findings are consistent with having increased awareness of strategies to promote reproducibility.
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http://dx.doi.org/10.1017/cts.2020.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057479PMC
June 2020

Workshop on reproducibility in research.

J Clin Transl Sci 2020 Jun 19;4(6):562-564. Epub 2020 Jun 19.

Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.

In recent years, concern about research reproducibility has increased dramatically for scientists, funders of research, and the general public. With a view to explicitly address what is often called a reproducibility crisis and putting the focus on research being done by individual trainees, a two-hour workshop was developed and introduced into six courses at UC San Diego. Participation in the workshop resulted in a statistically significant increase in the number of different types of strategies identified by the trainees for fostering reproducibility. The findings are consistent with having increased awareness of strategies to promote reproducibility.
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http://dx.doi.org/10.1017/cts.2020.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057479PMC
June 2020

Religiosity and Spirituality in the Stages of Recovery From Persistent Mental Disorders.

J Nerv Ment Dis 2021 02;209(2):106-113

Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.

Abstract: The impact of religiosity and spirituality (R/S) on mental health and the importance of incorporating R/S in mental health treatment have been previously explored. However, clarification is needed regarding the effects of R/S in the process of recovery from persistent mental disorders (PMDs). This study identifies how different R/S factors correlate with the stages of recovery, while considering individual psychological well-being and perceived social support. Seventy-five individuals who use Madrid's public services for people with PMD completed questionnaires assessing those factors. We found that during the recovery process, R/S correlated with psychological well-being and perceived social support, and that these variables were associated with the five stages of recovery differently. We further identified the importance of gratitude, compassion, inner peace, and connection with life in the recovery process. Overall, our findings highlight the importance of these R/S variables in particular recovery stages for individuals with PMD.
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http://dx.doi.org/10.1097/NMD.0000000000001271DOI Listing
February 2021

Assessing the Accuracy of Medical Intuition: A Subjective and Exploratory Study.

J Altern Complement Med 2020 Dec 27;26(12):1130-1135. Epub 2020 Oct 27.

Department of Family Medicine and Public Health, Center of Excellence for Research and Training in Integrative Health, University of California, San Diego, La Jolla, CA, USA.

Medical Intuition is a system of expanded perception gained through the human sense of intuition. Medical Intuition focuses on visualization skills and intuitive and innovative scanning to obtain information from the physical body and its energy systems. Medical Intuition is designed to assist health care providers in a cost-effective, targeted approach to a patient's presenting concerns, and is not meant to serve as a diagnosis of illness or disease. This exploratory study examined subjective accuracy and rates of acceptance of trained Medical Intuitives. Sixty-seven adult women and men served as study participants. The procedure for each medical intuition session was standardized. Thirty or 60-min sessions were conducted by phone or video. The participant verbally provided their name at the beginning of the session. The Medical Intuitives were instructed not to engage in any conversation with the participant other than telling them the information they were "seeing" during the scanning process. Following the session, each participant completed an anonymous online standardized case report form documenting their assessment of the reading. Findings included a 94% accuracy rate of the Medical Intuitive's ability to locate and evaluate the participant's primary physical issue; 100% accuracy to locate a secondary physical issue (86% of participants responding); 98% accuracy in describing the participant's life events, and 93% accuracy in describing a connection between the life events and health issues. These initial findings suggest that trained Medical Intuitives have strong subjectively reported accuracy rates identifying primary and secondary health issues and that their services are positively evaluated in the context of an individual's concerns regarding their health.
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http://dx.doi.org/10.1089/acm.2020.0244DOI Listing
December 2020

Modulatory Effects of Triphala and Manjistha Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.

J Altern Complement Med 2020 Nov 18;26(11):1015-1024. Epub 2020 Sep 18.

Department of Dermatology, University of California Davis, Sacramento, CA, USA.

Triphala (which contains and ) and manjistha (), have received increased clinical attention. The aim of the study was to evaluate the effects of triphala, manjistha, or placebo dietary supplementation on gut microbiota as such studies in humans are lacking. This was a 4-week randomized, double-blind, placebo-controlled pilot trial. This trial was conducted at the University of California Davis, Department of Dermatology. A total of 31 healthy human subjects were randomized to 3 groups. The 3 groups were instructed to take 2,000 mg of either triphala, manjistha or placebo daily for 4 weeks. The impact of treatment on gut microbiota composition was evaluated following a 4-week dietary intervention by profiling fecal communities with 16S rRNA profiling in triphala ( = 9), manjistha ( = 9), or placebo ( = 11) treated subjects that completed the intervention. An average of 336 phylotypes were detected in each sample (range: 161 to 648). The analysis of gut microbiota in placebo control and herb-supplemented participants indicated that responses were highly personalized, and no taxa were uniformly altered by the medicinal herb supplementation protocol. Subjects in both treatment groups displayed a trend toward decreased Firmicutes to Bacteroidetes ratio and increased relative abundance of . Both medicinal herb treatments reduced the relative abundance of Rikenellaceae, primarily reflecting changes in spp. Dietary supplementation with medicinal herbs altered fecal microbial communities. Despite the lack of a clear response signature, a group of bacterial taxa were identified that were more commonly altered in herb-supplemented participants compared to placebo controls. Clinicaltrials.gov identifier NCT03477825.
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http://dx.doi.org/10.1089/acm.2020.0148DOI Listing
November 2020

Changes in Continuous, Long-Term Heart Rate Variability and Individualized Physiological Responses to Wellness and Vacation Interventions Using a Wearable Sensor.

Front Cardiovasc Med 2020 31;7:120. Epub 2020 Jul 31.

Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States.

There are many approaches to maintaining wellness, including taking a simple vacation to attending highly structured wellness retreats, which typically regulate the attendee's personal time and activities. In a healthy English-speaking cohort of 112 women and men (aged 30-80 years), this study examined the effects of participating in either a 6-days intensive wellness retreat based on Ayurvedic medicine principles or unstructured 6-days vacation at the same wellness center setting. Heart rate variability (HRV) was monitored continuously using a wearable ECG sensor patch for up to 7 days prior to, during, and 1-month following participation in the interventions. Additionally, salivary cortisol levels were assessed for all participants at multiple times during the day. Continual HRV monitoring data in the real-world setting was seen to be associated with demographic [HRV: β = 0.98 (95% CI = 0.96-0.98), false discovery rate (FDR) < 0.001] and physiological characteristics [HRV: β = 0.98 (95% CI = 0.98-1), FDR =0.005] of participants. HRV features were also able to quantify known diurnal variations [HRV: β = 2.69 (SE = 1.26), FDR < 0.001] along with notable inter- and intraperson heterogeneity in response to intervention. A statistically significant increase in HRV [β = 1.48 (SE = 1.1), FDR < 0.001] was observed for all participants during the resort visit. Personalized HRV analysis at an individual level showed a distinct individualized response to intervention, further supporting the utility of using continuous real-world tracking of HRV at an individual level to objectively measure responses to potentially stressful or relaxing settings.
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http://dx.doi.org/10.3389/fcvm.2020.00120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411743PMC
July 2020

Meditation and Yoga Practices as Potential Adjunctive Treatment of SARS-CoV-2 Infection and COVID-19: A Brief Overview of Key Subjects.

J Altern Complement Med 2020 Jul 22;26(7):547-556. Epub 2020 Jun 22.

Department of Family Medicine and Public Health, Center of Excellence for Integrative Health, Institute for Public Health, University of California, San Diego, La Jolla, CA, USA.

As an acute condition quickly associated with multiple chronic susceptibilities, COVID-19 has rekindled interest in, and controversy about, the potential role of the host in disease processes. While hundreds of millions of research dollars have been funneled into drug and vaccine solutions that target the external agent, integrative practitioners tuned to enhancing immunity faced a familiar mostly unfunded task. First, go to school on the virus. Then draw from the global array of natural therapies and practices with host-enhancing or anti-viral capabilities to suggest integrative treatment strategies. The near null-set of conventional treatment options propels this investigation. In this paper, researchers from the Massachusetts Institute of Technology, University of California-San Diego, Chopra Library for Integrative Studies, and Harvard University share one such exploration. Their conclusion, that "certain meditation, yoga asana (postures), and pranayama (breathing) practices may possibly be effective adjunctive means of treating and/or preventing SARS-CoV-2 infection" underscores the importance of this rekindling. At JACM, we are pleased to have the opportunity to publish this work. We hope that it might help diminish in medicine and health the polarization that, like so much in the broader culture, seems to be an obstacle to healing. , JACM.
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http://dx.doi.org/10.1089/acm.2020.0177DOI Listing
July 2020

Nondual Awareness and the Whole Person.

Glob Adv Health Med 2020 21;9:2164956120914600. Epub 2020 May 21.

Department of Psychology, New York University, New York, New York.

Integrative Health aims to treat the whole person and to do so within the context of whole systems and practices. We raise questions as to what constitutes the whole person and what must be taken into account to support the creation of optimal well-being. We propose that in order to fully account for the whole person, the transcendent aspects of human awareness, the development of which is the goal of many meditative traditions, must be taken into account. "Nondual awareness" is a term increasingly used in the literature to describe a state of awareness that is characterized by the experience of nonseparation, compassion, and love. Well-being in this state does not depend on anything being experienced per se, but it is rather an innate attribute of living in nonduality. For these reasons, nondual awareness can be considered foundational to the realization of the whole person and achieving the state of optimal well-being.
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http://dx.doi.org/10.1177/2164956120914600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243377PMC
May 2020

Greater Well-Being in More Physically Active Cancer Patients Who Are Enrolled in Supportive Care Services.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420921439

University of California San Diego, La Jolla, CA, USA.

Cancers are one of the leading causes of mortality worldwide. Cancer patients are increasingly seeking integrative care clinics to promote their health and well-being during and after treatment. To examine relationships between physical activity (PA) and quality of life (QoL) in a sample of cancer patients enrolling in integrative care in a supportive care clinic. Also, to explore circulating inflammatory biomarkers and heart rate variability (HRV) in relationship to PA and QoL. A cross-sectional design of adult patients who sought care in the InspireHealth clinic, Vancouver, British Columbia, Canada. Patients with complete PA data (n = 118) answered psychosocial questionnaires, provided blood samples, and received HRV recordings before enrollment. Patients were stratified into "less" versus "more" active groups according to PA guidelines (150 minutes of moderate or 75 minutes of vigorous PA or an equivalent combination). Breast (33.1%) and prostate (10.2%) cancers were the most prevalent primary diagnoses. Patients engaging in more PA reported better physical ( = 1265.5, = .013), functional ( = 1306.5, = .024), and general QoL ( = 1341, = .039), less fatigue ( = 1268, = .014), fewer physical cancer-related symptoms ( = 2.338, = .021), and less general distress ( = 2.061, = .021). Between PA groups, type of primary cancer diagnosis differed (χ = 41.79, = .014), while stages of cancer did not (χ = 3.95, = .412). Fewer patients reported depressed mood within the more active group (χ = 6.131, = .047). More active patients were also less likely to have ever used tobacco (χ = 7.41, = .025) and used fewer nutritional supplements (χ = 39.74, ≤ .001). An inflammatory biomarker index was negatively correlated with vigorous PA ( = -0.215, = .022). Multivariable linear regression ( = 0.71) revealed that age (β = 0.22; = .001), fatigue (β = -0.43; ≤ .001), anxiety (β = -0.14; = .048), and social support (β = 0.38; = .001) were significant correlates of QoL.
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http://dx.doi.org/10.1177/1534735420921439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265567PMC
July 2021

Is Belonging to a Religious Organization Enough? Differences in Religious Affiliation Versus Self-ratings of Spirituality on Behavioral and Psychological Variables in Individuals with Heart Failure.

Healthcare (Basel) 2020 May 8;8(2). Epub 2020 May 8.

Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA.

In the United States, heart failure (HF) affects approximately 6.5 million adults. While studies show that individuals with HF often suffer from adverse symptoms such as depression and anxiety, studies also show that these symptoms can be at least partially offset by the presence of spiritual wellbeing. In a sample of 327 men and women with AHA/ACC classification Stage B HF, we found that more spirituality in patients was associated with better clinically-related symptoms such as depressed mood and anxiety, emotional variables (affect, anger), well-being (optimism, satisfaction with life), and physical health-related outcomes (fatigue, sleep quality). These patients also showed better self-efficacy to maintain cardiac function. Simply belonging to a religious organization independent of spiritualty, however, was not a reliable predictor of health-related benefits. In fact, we observed instances of belonging to a religious organization unaccompanied by parallel spiritual ratings, which appeared counterproductive.
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http://dx.doi.org/10.3390/healthcare8020129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349115PMC
May 2020

Effects of Psychosocial Interventions and Caregiving Stress on Cardiovascular Biomarkers in Family Dementia Caregivers: The UCSD Pleasant Events Program (PEP) Randomized Controlled Trial.

J Gerontol A Biol Sci Med Sci 2020 10;75(11):2215-2223

Department of Psychiatry, University of California San Diego, La Jolla.

Background: This study examined whether biological mechanisms linking dementia caregiving with an increased risk of coronary heart disease can be modified by psychosocial interventions and which caregivers might benefit the most from an intervention.

Methods: Spousal dementia caregivers were randomized to 12-week treatment with either a behavioral activation intervention (ie, Pleasant Events Program [PEP]; n = 60), or an active control Information and Support (IS; n = 63) condition. Indicators of caregiving stress were assessed pretreatment and circulating cardiovascular biomarkers were measured pre- and posttreatment.

Results: There were no significant changes in biomarker levels from pre- to posttreatment both by treatment condition and across all caregivers. Regardless of the treatment condition, exploratory regression analysis revealed that caregivers were more likely to show significant decreases in C-reactive protein (CRP) and D-dimer when their spouse had severe functional impairment; in interleukin (IL)-6 and CRP when they had greater distress due to care recipient's problem behaviors; in tumor necrosis factor (TNF)-α when they had higher levels of negative affect; and in IL-6, CRP, TNF-α, and D-dimer when they had higher personal mastery. Within the PEP group, caregivers with higher negative affect and those with higher positive affect were more likely to show a reduction in von Willebrand factor and D-dimer, respectively. Within the IS group, caregivers whose spouse had severe functional impairment were more likely to show a decrease in IL-6.

Conclusions: Unlike the average caregiver, caregivers high in burden/distress and resources might benefit from psychosocial interventions to improve cardiovascular risk, although these observations need confirmation.
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http://dx.doi.org/10.1093/gerona/glaa079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566538PMC
October 2020

Effects of Caloric Intake and Aerobic Activity in Individuals with Prehypertension and Hypertension on Levels of Inflammatory, Adhesion and Prothrombotic Biomarkers-Secondary Analysis of a Randomized Controlled Trial.

J Clin Med 2020 Feb 28;9(3). Epub 2020 Feb 28.

Department of Psychiatry, University of California, San Diego, CA 92093, USA.

Background: Cardiopulmonary fitness and low calorie diets have been shown to reduce inflammation but few studies have been conducted in individuals with elevated blood pressure (BP) in a randomized intervention setting. Thereby, adhesion biomarkers, e.g., soluble intercellular adhesion molecule (sICAM)-3, have not been examined so far.

Methods: Sixty-eight sedentary prehypertensive and mildly hypertensive individuals (mean age ± SEM: 45 ± 1 years; mean BP: 141/84 ± 1/1 mmHg) were randomized to one of three 12-week intervention groups: cardio training and caloric reduction, cardio training alone, or wait-list control group. Plasma levels of inflammatory, adhesion and prothrombotic biomarkers were assessed. In a second step, intervention groups were combined to one sample and multivariate regression analyses were applied in order to account for exercise and diet behavior changes.

Results: There were no significant differences among the intervention groups. In the combined sample, greater caloric reduction was associated with a larger increase of sICAM-3 ( = 0.026) and decrease of C-reactive protein ( = 0.018) as a result of the interventions. More cardio training was associated with increases of sICAM-3 ( = 0.046) as well as interleukin-6 ( = 0.004) and a decrease of tumor necrosis factor- ( = 0.017) levels. Higher BP predicted higher plasminogen activator inhibitor (PAI)-1 ( = 0.001), and greater fitness predicted lower PAI-1 levels ( = 0.006) after the intervention.

Conclusions: In prehypertensive and hypertensive patients, plasma levels of the adhesion molecule sICAM-3 and inflammatory biomarkers have different response patterns to cardio training with and without caloric reduction. Such anti-inflammatory and anti-thrombotic effects may have implications for the prevention of atherothrombotic cardiovascular disease among individuals at increased risk.
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http://dx.doi.org/10.3390/jcm9030655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141349PMC
February 2020

Examining the mediating role of perceived stress in the relationship between mindfulness and quality of life and mental health: testing the mindfulness stress buffering model.

Anxiety Stress Coping 2020 05 6;33(3):311-325. Epub 2020 Feb 6.

Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.

Many studies show that mindfulness can improve quality of life and mental health as well as reduce psychological distress; however, the mechanisms of these effects remain unknown. The mindfulness stress buffering model provides a model for explaining the effects of mindfulness on health outcomes through the mechanism of reducing perceived stress. Therefore, we investigated the mediating role of perceived stress in the relationship between mindfulness and quality of life and mental health. Three hundred and fifteen soldiers completed the Mindful Attention Awareness scale, Perceived Stress Scale, WHO Quality of Life Assessment, and General Health Questionnaire. Structural equation modeling using bootstrap methods was employed to analyze the data. Results showed that perceived stress partially mediated the relationship between mindfulness and quality of life, and that perceived stress fully mediated the relationship between mindfulness and mental health. Mindfulness yields beneficial effects in improving individuals' quality of life and improving mental health through reducing perceived stress.
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http://dx.doi.org/10.1080/10615806.2020.1723006DOI Listing
May 2020

A Randomized Study Examining the Effects of Mild-to-Moderate Group Exercises on Cardiovascular, Physical, and Psychological Well-being in Patients With Heart Failure.

J Cardiopulm Rehabil Prev 2019 11;39(6):403-408

Departments of Psychiatry (Drs Redwine, Rutledge, and Mills and Ms Chinh) and Family Medicine and Public Health (Ms Wilson and Drs Pung and Mills), University of California, San Diego; and College of Nursing, University of South Florida, Tampa (Drs Redwine and Smith).

Purpose: To compare 2 mild-to-moderate group exercises and treatment as usual (TAU) for improvements in physical function and depressive symptoms.

Methods: Patients with heart failure (n = 70, mean age = 66 yr, range = 45-89 yr) were randomized to 16 wk of tai chi (TC), resistance band (RB) exercise, or TAU.

Results: Physical function differed by group from baseline to follow-up, measured by distance walked in the 6-min walk test (F = 3.19, P = .03). Tai chi participants demonstrated a nonsignificant decrease of 162 ft (95% confidence interval [CI], 21 to -345, P = .08) while distance walked by RB participants remained stable with a nonsignificant increase of 70 ft (95% CI, 267 to -127, P = .48). Treatment as usual group significantly decreased by 205 ft (95% CI, -35 to -374, P = .02) and no group differences occurred over time in end-systolic volume (P = .43) and left ventricular function (LVEF) (P = .67). However, groups differed over time in the Beck Depression Inventory (F = 9.2, P < .01). Both TC and RB groups improved (decreased) by 3.5 points (95% CI, 2-5, P < .01). Treatment as usual group decreased insignificantly 1 point (95% CI, -1 to 3, P = .27).

Conclusions: Tai chi and RB participants avoided a decrease in physical function decrements as seen with TAU. No groups changed in cardiac function. Both TC and RB groups saw reduced depression symptoms compared with TAU. Thus, both TC and RB groups avoided a decrease in physical function and improved their psychological function when compared with TAU.
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http://dx.doi.org/10.1097/HCR.0000000000000430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832782PMC
November 2019

Prebiotic Potential of Culinary Spices Used to Support Digestion and Bioabsorption.

Evid Based Complement Alternat Med 2019 2;2019:8973704. Epub 2019 Jun 2.

Sanford Burnham Prebys Medical Discovery Institute, Bioinformatics and Structural Biology Program, La Jolla, CA, USA.

Although the impact of medicinal and culinary herbs on health and disease has been studied to varying extents, scarcely little is known about the impact of these herbs on gut microbiota and how such effects might contribute to their health benefits. We applied anaerobic cultivation of human fecal microbiota followed by 16S rRNA sequencing to study the modulatory effects of 4 culinary spices: (turmeric), (ginger), (pipli or long pepper), and (black pepper). All herbs analyzed possessed substantial power to modulate fecal bacterial communities to include potential prebiotic and beneficial repressive effects. We additionally analyzed the sugar composition of each herb by mass spectrometry and conducted genome reconstruction of 11 relevant sugar utilization pathways, glycosyl hydrolase gene representation, and both butyrate and propionate biosynthesis potential to facilitate our ability to functionally interpret microbiota profiles. Results indicated that sugar composition is not predictive of the taxa responding to each herb; however, glycosyl hydrolase gene representation is strongly modulated by each herb, suggesting that polysaccharide substrates present in herbs provide selective potential on gut communities. Additionally, we conclude that catabolism of herbs by gut communities primarily involves sugar fermentation at the expense of amino acid metabolism. Among the herbs analyzed, only turmeric induced changes in community composition that are predicted to increase butyrate-producing taxa. Our data suggests that substrates present in culinary spices may drive beneficial alterations in gut communities thereby altering their collective metabolism to contribute to the salubrious effects on digestive efficiency and health. These results support the potential value of further investigations in human subjects to delineate whether the metabolism of these herbs contributes to documented and yet to be discovered health benefits.
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http://dx.doi.org/10.1155/2019/8973704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590564PMC
June 2019

The Relationship Between Circulating Interleukin-6 Levels and Future Health Service Use in Dementia Caregivers.

Psychosom Med 2019 09;81(7):668-674

From the Department of Psychiatry (Mausbach, Dimsdale, Mills, Patterson, Ancoli-Israel, Grant), University of California San Diego, La Jolla; Department of Psychology (Decastro), San Diego State University, California; Department of Psychology (Vara-Garcia), University Rey Juan Carlos, Madrid, Spain; Joint Doctoral Program in Clinical Psychology (Bos), San Diego State University and University of California San Diego; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine (von Känel), University Hospital Zurich, Switzerland; Departments of Medicine (Ziegler) and Family and Preventive Medicine (Allison, Mills); and Department of Family Medicine and Public Health (Pruitt), University of California San Diego, La Jolla.

Objective: Older adults are among the most frequent users of emergency departments (EDs). Nonspecific symptoms, such as fatigue and widespread pain, are among the most common symptoms in patients admitted at the ED. Interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) are inflammation biomarkers associated with chronic stress (i.e., dementia caregiving) and nonspecific symptoms. This study aimed to determine whether IL-6 and TNF-α were prospectively associated with ED risk in dementia caregivers (CGs).

Methods: Participants were 85 dementia CGs, who reported during three assessments (3, 9, and 15 months after enrollment) if they had visited an ED for any reason. Cox proportional hazards models were used to examine the relations between resting circulating levels of IL-6 and TNF-α obtained at enrollment and subsequent risk for an ED visit, adjusting for age, sex, use of ED 1 month before enrollment, physical and mental health well-being, body mass index, and CG demands.

Results: (log) IL-6 significantly predicted ED visits during the 15-month follow-up (B = 1.96, SE = 0.82, p = .017). For every (log) picogram per milliliter increase in IL-6, the risk of visiting an ED was 7.10 times greater. TNF-α was not associated with subsequent ED visits. Exploratory analyses suggested that CGs with levels of IL-6 above the 80th percentile and experiencing high CG demands were at highest risk of an ED visit.

Conclusions: IL-6 levels and CG demands may be useful for predicting vulnerability for future ED visits. Although further studies should be conducted to replicate and extend these findings, interventions that successfully modify inflammation markers, including the underlying pathophysiology related to stress and/or comorbid illnesses, may be useful in preventing costly and detrimental outcomes in this population.
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http://dx.doi.org/10.1097/PSY.0000000000000716DOI Listing
September 2019

Psychosocial Effects of a Holistic Ayurvedic Approach to Well-being in Health and Wellness Courses.

Glob Adv Health Med 2019 29;8:2164956119843814. Epub 2019 Apr 29.

Department of Family Medicine and Public Health, Center of Excellence for Research and Training in Integrative Health, University of California San Diego, La Jolla, California.

Background: As individuals are increasingly attending health and wellness courses outside of the conventional medical system, there is a need to obtain objective data on the effects of those programs on well-being.

Methods: In total, 154 men and women (mean age 54.7 years; range 25-83) participated in 3 different holistic wellness programs based on Ayurvedic Medicine principles (Seduction of Spirit, Journey into Healing, and Perfect Health) or a vacation control group. Psychosocial outcomes included spirituality (Delaney Spirituality Scale), mindful awareness (Mindful Attention Awareness Scale), psychological flexibility (Acceptance and Action Questionnaire), mood (Center for Epidemiology Studies-Depression), and anxiety (Patient-Reported Outcomes Measurement System Anxiety Scale).

Results: Participants in the Seduction of Spirit ( < .004), Journey into Healing ( < .05), and Perfect Health ( < .004) courses showed significant increases in spirituality as compared to vacation controls. Participants in Seduction of Spirit ( < .007) also showed significant increases in mindfulness as compared to vacation controls. Participants in the Seduction of Spirit ( < .001) and Journey into Healing ( < .05) courses showed significant decreases in depressed mood as compared to those in the Perfect Health and vacation control groups. All study participants showed similar increases in psychological flexibility ( < .01) and decreases in anxiety ( < .01).

Conclusion: Participation in wellness courses that incorporate a mind-body-spirit approach to health improves multiple domains of psychosocial well-being, which persists even after course participation.
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http://dx.doi.org/10.1177/2164956119843814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492358PMC
April 2019

Depressive symptoms in asymptomatic stage B heart failure with Type II diabetic mellitus.

Clin Cardiol 2019 Jun 29;42(6):637-643. Epub 2019 Apr 29.

Department of Medicine, University of California San Diego, San Diego, California.

Background: The presence of concomitant Type II diabetic mellitus (T2DM) and depressive symptoms adversely affects individuals with symptomatic heart failure (HF).

Hypothesis: In presymptomatic stage B HF, this study hypothesized the presence of greater inflammation and depressive symptoms in T2DM as compared to non-T2DM Stage B patients.

Methods: This cross-sectional study examined clinical parameters, inflammatory biomarkers, and depressive symptoms in 349 T2DM and non-T2DM men with asymptomatic stage B HF (mean age 66.4 years ±10.1; range 30-91).

Results: Fewer diabetic HF patients had left ventricular (LV) systolic dysfunction (P < .05) although more had LV diastolic dysfunction (P < .001). A higher percentage of T2DM HF patients were taking ACE-inhibitors, beta-blockers, calcium channel blockers, statins, and diuretics (P values < .05). T2DM HF patients had higher circulating levels of interleukin-6 (IL-6) (P < .01), tumor necrosis factor-alpha (P < .01), and soluble ST2 (sST2) (P < .01) and reported more somatic/affective depressive symptoms (Beck Depression Inventory II) (P < .05) but not cognitive/affective depressive symptoms (P = .20). Among all patients, in a multiple regression analysis predicting presence of somatic/affective depressive symptoms, sST2 (P = .026), IL-6 (P = .010), B-type natriuretic peptide (P = .016), and sleep (Pittsburgh Sleep Quality Index [P < .001]) were significant predictors (overall model F = 15.39, P < .001, adjusted R = .207).

Conclusions: Somatic/affective but not cognitive/affective depressive symptoms are elevated in asymptomatic HF patients with T2DM patients. Linkages with elevated inflammatory and cardiac relevant biomarkers suggest shared pathophysiological mechanisms among T2DM HF patients with somatic depression, and these conditions are responsive to routine interventions, including behavioral. Copyright © 2019 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/clc.23187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553353PMC
June 2019

Elevated Resting and Postprandial Digestive Proteolytic Activity in Peripheral Blood of Individuals With Type-2 Diabetes Mellitus, With Uncontrolled Cleavage of Insulin Receptors.

J Am Coll Nutr 2019 08 9;38(6):485-492. Epub 2019 Apr 9.

d Department of Family Medicine and Public Health, University of California San Diego , La Jolla , California , USA.

: To examine resting and postprandial peripheral protease activity in healthy controls and individuals with type 2 diabetes mellitus (T2DM) and pre-T2DM. : Individuals with T2DM or pre-T2DM and healthy controls (mean age 55.8 years) were studied before and for a span of 300 minutes following a single high-calorie McDonald's breakfast. Metalloproteases-2/-9 (MMP-2/-9), elastase, and trypsin activities were assessed in whole blood before and following the meal using a novel high-precision electrophoretic platform. Also assessed were circulating levels of inflammatory biomarkers and insulin receptor density on peripheral blood mononuclear cells (PBMCs) in relationship to protease activity. : Premeal MMP-2/-9 and elastase activity levels in T2DM and in pre-T2DM participants were significantly elevated as compared to controls. The T2DM group showed a significant increase in elastase activity 15 minutes after the meal; elastase activity continued to increase to the 30-minute time point ( < 0.01). In control participants, MMP-2/-9, elastase, and trypsin were significantly increased at 15 minutes after the meal ( < 0.05) and returned to premeal values within a period of approximately 30 to 60 minutes post meal. PBMCs incubated for 1 hour with plasma from T2DM and pre-T2DM participants had significantly lower levels of insulin receptor density compared to those incubated with plasma from control participants ( < 0.001). : The results of this study suggest that individuals with T2DM and pre-T2DM have higher resting systemic protease activity than nonsymptomatic controls. A single high-calorie/high-carbohydrate meal results in further elevations of protease activity in the systemic circulation of T2DM and pre-T2DM, as well as in healthy controls. The protease activity in turn can lead to a downregulation of insulin receptor density, potentially supporting a state of insulin resistance.
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http://dx.doi.org/10.1080/07315724.2018.1545611DOI Listing
August 2019

Glyphosate Excretion is Associated With Steatohepatitis and Advanced Liver Fibrosis in Patients With Fatty Liver Disease.

Clin Gastroenterol Hepatol 2020 03 4;18(3):741-743. Epub 2019 Apr 4.

NAFLD Research Center, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California.

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in developed countries. Patients with nonalcoholic steatohepatitis (NASH) are considered to be at a higher risk of fibrosis progression and development to cirrhosis and hepatocellular carcinoma.
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http://dx.doi.org/10.1016/j.cgh.2019.03.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776714PMC
March 2020

16S rRNA gene profiling and genome reconstruction reveal community metabolic interactions and prebiotic potential of medicinal herbs used in neurodegenerative disease and as nootropics.

PLoS One 2019 19;14(3):e0213869. Epub 2019 Mar 19.

Sanford Burnham Prebys Medical Discovery Institute, Bioinformatics and Structural Biology Program, La Jolla, California, United States of America.

The prebiotic potential of nervine herbal medicines has been scarcely studied. We therefore used anaerobic human fecal cultivation to investigate whether medicinal herbs commonly used as treatment in neurological health and disease in Ayurveda and other traditional systems of medicine modulate gut microbiota. Profiling of fecal cultures supplemented with either Kapikacchu, Gotu Kola, Bacopa/Brahmi, Shankhapushpi, Boswellia/Frankincense, Jatamansi, Bhringaraj, Guduchi, Ashwagandha or Shatavari by 16S rRNA sequencing revealed profound changes in diverse taxa. Principal coordinate analysis highlights that each herb drives the formation of unique microbial communities predicted to display unique metabolic potential. The relative abundance of approximately one-third of the 243 enumerated species was altered by all herbs. Additional species were impacted in an herb-specific manner. In this study, we combine genome reconstruction of sugar utilization and short chain fatty acid (SCFA) pathways encoded in the genomes of 216 profiled taxa with monosaccharide composition analysis of each medicinal herb by quantitative mass spectrometry to enhance the interpretation of resulting microbial communities and discern potential drivers of microbiota restructuring. Collectively, our results indicate that gut microbiota engage in both protein and glycan catabolism, providing amino acid and sugar substrates that are consumed by fermentative species. We identified taxa that are efficient amino acid fermenters and those capable of both amino acid and sugar fermentation. Herb-induced microbial communities are predicted to alter the relative abundance of taxa encoding SCFA (butyrate and propionate) pathways. Co-occurrence network analyses identified a large number of taxa pairs in medicinal herb cultures. Some of these pairs displayed related culture growth relationships in replicate cultures highlighting potential functional interactions among medicinal herb-induced taxa.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213869PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424447PMC
December 2019

Refining caregiver vulnerability for clinical practice: determinants of self-rated health in spousal dementia caregivers.

BMC Geriatr 2019 01 22;19(1):18. Epub 2019 Jan 22.

Department of Psychiatry, University of California San Diego, La Jolla, California, USA.

Background: Caregivers of a family member with a chronic disability or illness such as dementia are at increased risk for chronic disease. There are many factors that contribute to dementia caregiver vulnerability and these factors can be challenging to assess in clinical settings. Self-rated health (SRH) is an independent measure of survival and physical health in the elderly. As an inclusive measure of health, SRH has been proposed as a reliable way to assess a patient's general health in primary care. Therefore, we sought to identify determinants of poor/fair SRH versus categories of at least good SRH in informal caregivers.

Methods: In a cross-sectional study, we examined 134 elderly (≥55 years) providing in-home care for a spouse with dementia who rated their own health with a single-item question: "In general, would you say your health is excellent, very good, good, fair or poor?". In a multivariable model, we compared caregivers with poor/fair SRH to those with good, very good, or excellent SRH on demographics, health characteristics (health behaviors, physical health indicators, psychosocial factors) and caregiving-specific stress (a composite index/total of four caregiving-specific stressors: years of caregiving, dementia severity, care recipient functional impairment and perceived caregiver burden).

Results: Compared with caregivers who rated their own health as either good (31.3%), very good (38.8%) or excellent (14.2%), caregivers with poor/fair SRH (15.7%) were more likely to have lower physical function and total greater caregiving-specific stress. More years of caregiving, severe dementia and care recipient functional impairment, but not perceived caregiver burden, were also more likely among caregivers with poor/fair SRH. Additionally, high negative affect and low positive affect were more likely in caregivers with poor/fair vs. good or excellent and very good or excellent SRH, respectively.

Conclusions: Caregivers with poor/fair SRH were characterized by higher levels of medical comorbidity, low physical function, high negative, but low positive affect and longer duration of caregiving, as well as more severe dementia and greater functional impairment of the care recipient. These findings suggest that caregivers need to be more closely evaluated and targeted for preventive interventions in clinical practice.

Trial Registration: ClinicalTrials.gov registration number: NCT02317523 .
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http://dx.doi.org/10.1186/s12877-019-1033-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343283PMC
January 2019

Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial.

Lancet Psychiatry 2018 12 15;5(12):975-986. Epub 2018 Nov 15.

VA San Diego Healthcare System, San Diego, CA, USA; Department of Family Medicine and Public Health, and Department of Psychiatry, University of California, San Diego, CA, USA.

Background: Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10-20% of military veterans. Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms. This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE).

Methods: We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually. The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (Δ=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123.

Findings: Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group). TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (-14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (-8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score.

Interpretation: A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD.

Funding: Department of Defense, US Army Medical Research.
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http://dx.doi.org/10.1016/S2215-0366(18)30384-5DOI Listing
December 2018

The Effects of Grounding (Earthing) on Bodyworkers' Pain and Overall Quality of Life: A Randomized Controlled Trial.

Explore (NY) 2019 May - Jun;15(3):181-190. Epub 2018 Oct 11.

Department of Family Medicine and Public Health, University of California, P.O. Box 231025, Encinitas, San Diego, La Jolla, CA, 92023, USA.

Background: It is well known that massage therapists routinely develop a number of health problems related to their profession.

Purpose: To determine the effects of grounding on massage therapists' quality of life and pain. Grounding, refers to being in direct body contact with the ground, such as walking barefoot on humid soil or on grass.

Setting: The Chopra Center for Well-Being in Carlsbad, California, USA.

Participants: Sixteen massage therapists (mean age 42.8 years).

Research Design And Intervention: A stepped wedge cluster design was incorporated into a 6-week double-blind Randomized Controlled Trial (RCT) procedure with massage therapists assigned randomly into one of two cohorts. Therapists were not grounded for the first week, were grounded while working on clients and at home while sleeping for the next four weeks, and then ungrounded for the last week.

Outcome Measures: Prior to, during, and immediately following the intervention, participants completed standardized questionnaires reporting on pain, physical function, anxiety, depression, fatigue/tiredness, sleep disturbance and number of hours of sleep, number of clients worked on per working day, energy, and emotional and mental stress.

Results: As a group, therapists experienced significant increases in physical function and energy and significant decreases in fatigue, depressed mood, tiredness and pain while grounded as compared to not being grounded. At one-month following the study, physical function was also increased and depressed mood and fatigue were decreased.

Conclusions: We observed consistent beneficial effects of grounding in domains highly relevant to massage therapists, namely pain, physical function, and mood. These findings, combined with prior results from this trial indicating improvements in inflammatory biomarkers, blood viscosity and heart rate variability (HRV), suggest that grounding is beneficial to massage therapists in multiple domains relevant to their occupation, supporting overall health and quality of life.
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http://dx.doi.org/10.1016/j.explore.2018.10.001DOI Listing
June 2020
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