Chao M.T.,University of California at San Francisco |
Tippens K.M.,Helfgott Research Institute |
Connelly E.,Helfgott Research Institute
Journal of Alternative and Complementary Medicine | Year: 2012
Objectives: Acupuncture utilization in the United States has increased in recent years, but is less common among racial/ethnic minorities and those of low socioeconomic status. Group-based, community acupuncture is a delivery model gaining in popularity around the United States, due in part to low-cost treatments provided on a sliding-fee scale. Affordable, community-based acupuncture may increase access to health care at a time when increasing numbers of people are uninsured. To assess the population using local community acupuncture clinics, sociodemographic factors, health status, and utilization patterns compared to national acupuncture users were examined. Design: Data were employed from (1) a cross-sectional survey of 478 clients of two community acupuncture clinics in Portland, Oregon and (2) a nationally representative sample of acupuncture users from the 2007 National Health Interview Survey. Results: Portland community acupuncture clients were more homogeneous racially, had higher educational attainment, lower household income, and were more likely to receive 10 or more treatments in the past 12 months (odds ratio=5.39, 95% confidence interval=3.54, 8.22), compared to a nationally representative sample of U.S. acupuncture users. Self-reported health status and medical reasons for seeking acupuncture treatment were similar in both groups. Back pain (21%), joint pain (17%), and depression (13%) were the most common conditions for seeking treatment at community acupuncture clinics. Conclusions: Study findings suggest that local community acupuncture clinics reach individuals of a broad socioeconomic spectrum and may allow for increased frequency of treatment. Limited racial diversity among community acupuncture clients may reflect local demographics of Portland. In addition, exposure to and knowledge about acupuncture is likely to vary by race and ethnicity. Future studies should examine access, patient satisfaction, frequency of treatment, and clinical outcomes of group-based models of community acupuncture clinics located in racially and socioeconomically diverse communities. © Copyright 2012, Mary Ann Liebert, Inc. 2012.
Hill J.,Helfgott Research Institute |
Hodsdon W.,Helfgott Research Institute
Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer | Year: 2014
The ubiquitous and detrimental disease of breast cancer requires continual research into new and alternative forms of treatment and prevention. The emerging field of epigenetics is beginning to unfold an array of contemporary approaches to reduce the risk and improve the clinical approach to breast cancer. The information contained in this non-systematic review highlights and expands on the estrogen-based model of breast cancer epigenetics to provide an overview of epigenetic alterations induced by nutrition and environmental exposure. The majority of evidence suggests that various sources of excess estrogen correlate to future breast cancer development. In addition, maternal macro- and micronutrient balance appear to play a role in genomic regulation, and preliminary data suggest that specific superfoods, such as blueberries, have a protective epigenetic effect. Identifying the influence of environmental toxicants, hormonal exposure, maternal nutrition, and maternal disease on fetal epigenetics may have potential for development of new therapeutic approaches for the prevention of breast cancer.
Thorburn S.,Oregon State University |
Faith J.,Oregon State University |
Keon K.L.,Independent Consultant |
Tippens K.M.,Helfgott Research Institute
Journal of Alternative and Complementary Medicine | Year: 2013
Objectives: Discrimination in medical settings may influence patient attitudes about health care and health-seeking behaviors. Patients who experience discrimination may seek alternative means of health care, including use of complementary and alternative medicine (CAM). The objective of this study was to examine the relationship between discrimination in health care and CAM use. Design: Data come from the 2001 Health Care Quality Survey (HCQS), which used a multistage sampling design with random-digit dialing, oversampling telephone exchanges with higher densities of African-American, Hispanic, and Asian households. The 2001 HCQS sample consisted of 6722 adults living in the continental United States. To correct for the disproportionate sample design, data were adjusted using sample weights to make the results representative of the U.S. population 18 years and older. Present analyses were limited to 6008 respondents who had visited a doctor or clinic or had been admitted to the hospital in the last 2 years. Outcome measures: Outcome measures were CAM use, practitioner-provided CAM use, and herbal medicine use. Results: In adjusted logistic regression analyses, discrimination in health care was significantly associated with use of herbal medicines alone (adjusted odds ratio=1.47, confidence interval: 1.05, 2.04), but not with use of practitioner-provided CAM (i.e., use of acupuncture, chiropractor, traditional healer or herbalist, alone or in combination with herbal medicines). Conclusions: Further research is needed to examine the direction of the relationship between discrimination and CAM use and differences by CAM modality. © 2013, Mary Ann Liebert, Inc.
Darnall B.D.,Oregon Health And Science University |
Aickin M.,University of Arizona |
Zwickey H.,Helfgott Research Institute
Gender Medicine | Year: 2010
Background: Recent evidence suggests that differential stress and immune responses may play a role in the sex/gender disparity for pain. Pain pathology and psychological stress are both associated with elevated levels of proinflammatory cytokines. Objective: This pilot study tested a negative imaginal focus to assess whether it would elicit a proinflammatory cytokine response and whether responses would vary by sex/gender. Methods: Adults with chronic musculoskeletal pain were recruited from an outpatient, multidisciplinary pain clinic in Portland, Oregon, between 2007 and 2008. All participants underwent a psychologist-guided 10-minute focus on the negative aspects of their pain condition and the imagined worsening of their pain; no control group was used. Serum collected at baseline and postfocus (1, 2, and 2.5 hours) was assayed for interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Cortisol was assayed at each time point and at 15 minutes postfocus. Results: Thirty-six outpatients (aged 26-62 years; 23 women, 13 men) participated in the study. Compared with men, women displayed greater negative emotional expression during the experiment, and this in turn mediated their IL-6 inflammatory responses. Relative to men, the IL-6 response trajectory was delayed for women. The IL-6 and TNF-a findings suggest women's maximal cytokine responses were not captured by the final time point. Conclusions: This pilot study provides preliminary evidence that women with chronic pain may experience increased and delayed inflammatory responses following negative emotional expression induced by thinking negatively about their pain condition. The findings have implications for pain catastrophizing research. This early-phase research suggests that the timing and duration of the cytokine response are critical factors to consider in future pain research. © 2010 Excerpta Medica Inc. All rights reserved.
Wahbeh H.,Oregon Health And Science University |
Zwickey H.,Helfgott Research Institute |
Oken B.,Oregon Health And Science University
Journal of Alternative and Complementary Medicine | Year: 2011
Objectives: Home practice is frequently prescribed as part of mind-body medicine interventions, although rarely objectively measured. This brief methods report describes one method for objectively measuring home practice adherence using a custom monitoring software program. Design: Methods for objectively measuring adherence were developed as part of a randomized controlled trial on the mechanisms of mindfulness meditation. Settings/location: The study was conducted at Oregon Health & Science University, Portland, Oregon. Subjects: The subjects comprised 11 combat veterans with post-traumatic stress disorder. Interventions: The method used was mindfulness meditation. Outcome measures: There were subjective and objective adherence measurements of mindfulness meditation home practice. Results: The first iteration of objective adherence monitoring used an iPod device and had limitations in participant usage and correctly capturing data. In the second iteration, objective data were easily collected, uploaded, and viewed using the custom software application, iMINDr. Participants reported that iMINDr was straightforward to use, and they returned the monitoring units as directed. Conclusions: The iMINDr is an example of a simple objective adherence measurement system that may help mind-body researchers examine how home practice adherence may affect outcomes in future clinical trials. © 2011, Mary Ann Liebert, Inc.
Senders A.,Oregon Health And Science University |
Senders A.,Helfgott Research Institute |
Hanes D.,Helfgott Research Institute |
Bourdette D.,Oregon Health And Science University |
And 4 more authors.
Multiple Sclerosis Journal | Year: 2014
Background: Patient-reported outcomes are important for clinical research and care, yet administering and scoringthe questionnaires requires considerable effort and time. The Patient Reported Outcomes Measurement InformationSystem (PROMIS) could considerably reduce administrative obstacles and lessen survey burden for participants.Objective: Assess the feasibility and validity of PROMIS, compared to commonly-used legacy measures for multiplesclerosis (MS).Methods: In this cross-sectional survey, 133 participants with confirmed MS completed legacy surveys and PROMISComputerized Adaptive Tests (CATs) for depression, anxiety, pain, fatigue and physical function. We conducted a multitrait,multi-method analysis and verified results with confirmatory factor analysis.Results: The correlations between PROMIS and the corresponding legacy measures were large (0.67 to 0.87). Themulti-trait, multi-method criteria were generally well met, providing good evidence of the validity of PROMIS measures.PROMIS surveys asked fewer questions and required substantially less time to complete than the legacy scales.Conclusions: Our results provide evidence of the construct validity of PROMIS for use with MS patients. Severalaspects of the PROMIS CATs made them an important resource, including: (a) less time was required to complete them;(b) missing data was reduced; and (c) the automatic scoring referenced the general population. Our findings support theuse of PROMIS in MS research and may have broader implications for clinical care, as well. © The Author(s) 2013.
Beil K.,Helfgott Research Institute |
Hanes D.,Helfgott Research Institute
International Journal of Environmental Research and Public Health | Year: 2013
Environments shape health and well-being, yet little research has investigated how different real-world environmental settings influence the well-known determinant of health known as stress. Using a cross-over experimental design; this pilot study investigated the effect of four urban environments on physiological and psychological stress measures. Participants (N = 15) were exposed on separate days to one of the four settings for 20 min. These settings were designated as Very Natural; Mostly Natural; Mostly Built and Very Built. Visitation order to the four settings was individually randomized. Salivary cortisol and alpha-amylase; as well as self-report measures of stress; were collected before and after exposure to each setting. Gender was included as a variable in analysis; and additional data about environmental self-identity, pre-existing stress, and perceived restorativeness of settings were collected as measures of covariance. Differences between environmental settings showed greater benefit from exposure to natural settings relative to built settings; as measured by pre-to-post changes in salivary amylase and self-reported stress; differences were more significant for females than for males. Inclusion of covariates in a regression analysis demonstrated significant predictive value of perceived restorativeness on these stress measures, suggesting some potential level of mediation. These data suggest that exposure to natural environments may warrant further investigation as a health promotion method for reducing stress. © 2013 by the authors; licensee MDPI, Basel, Switzerland.
Litchy A.P.,Helfgott Research Institute
Journal of Dietary Supplements | Year: 2011
The use of Complimentary and Alternative Medicine (CAM) is increasing in the United States; there is a need for physician level practitioners who possess extensive training in both CAM and conventional medicine. Naturopathic physicians possess training that allows integration of modern scientific knowledge and the age-old wisdom of natural healing techniques. Naturopathic philosophy provides a framework to implement CAM in concert with conventional therapies. The naturopathic physician's expertise in both conventional medicine and CAM allows a practice style that provides excellent care through employing conventional and CAM modalities while utilizing modern research and evidence-based medicine. © 2011 Informa Healthcare USA, Inc.
He J.,Tulane University |
Wofford M.R.,University of Mississippi Medical Center |
Reynolds K.,Tulane University |
Reynolds K.,Kaiser Permanente |
And 7 more authors.
Circulation | Year: 2011
Background-Observational studies have reported an inverse association between dietary protein intake and blood pressure (BP). We compared the effect of soy protein, milk protein, and carbohydrate supplementation on BP among healthy adults. Methods and Results-We conducted a randomized, double-blind crossover trial with 3 intervention phases among 352 adults with prehypertension or stage 1 hypertension in New Orleans, LA, and Jackson, MS, from September 2003 to April 2008. The trial participants were assigned to take 40 g/d soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a random order. A 3-week washout period was implemented between the interventions. Three BPs were measured at 2 baseline and 2 termination visits during each of 3 intervention phases with a random-zero sphygmomanometer. Compared with carbohydrate controls, soy protein and milk protein supplementations were significantly associated with -2.0 mm Hg (95% confidence interval -3.2 to -0.7 mm Hg, P=0.002) and -2.3 mm Hg (-3.7 to -1.0 mm Hg, P=0.0007) net changes in systolic BP, respectively. Diastolic BP was also reduced, but this change did not reach statistical significance. There was no significant difference in the BP reductions achieved between soy or milk protein supplementation. Conclusions-The results from this randomized, controlled trial indicate that both soy and milk protein intake reduce systolic BP compared with a high-glycemic-index refined carbohydrate among patients with prehypertension and stage 1 hypertension. Furthermore, these findings suggest that partially replacing carbohydrate with soy or milk protein might be an important component of nutrition intervention strategies for the prevention and treatment of hypertension. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00107744. © 2011 American Heart Association, Inc.
Faith J.,Oregon State University |
Thorburn S.,Oregon State University |
Tippens K.M.,Helfgott Research Institute
Complementary Therapies in Medicine | Year: 2013
Objectives: To improve understanding of factors that may influence disclosure of complementary and alternative medicine (CAM) use in the U.S. Design: Cross-sectional survey. Methods: Data are from the 2001 Health Care Quality Survey (HCQS), a nationally representative study of adults aged 18 and older living in the continental United States. Using the Behavioral Model of Health Services Use, we conducted multivariate logistic regressions to identify factors associated with disclosing CAM use among the sub-sample of recent CAM users (n=1995). Main outcome measure: Disclosure of CAM use. Results: Most CAM users (71.0%) disclosed their use of CAM to their doctors. Contextual, individual, and health behavior factors were associated with CAM use disclosure. Of particular interest, disclosure was significantly more likely among those who perceived high quality relationships with their providers (AOR = 1.59, CI: 1.01, 2.49) and among those who had a regular source of medical care (AOR = 1.54, CI: 1.03, 2.29). The odds of disclosure were also higher among those who used practitioner-provided CAM, with (AOR = 2.02, CI: 1.34, 3.06) or without (AOR = 1.52, CI: 1.05, 2.20) concurrent herbal medicine use, compared to those who used herbal medicines only. Conclusions: The Behavioral Model of Health Services Use is a useful framework for examining factors that may influence disclosure of CAM use. Further research should examine these relationships using more comprehensive measures. © 2013 Elsevier Ltd.