Science Says

Sepsis is a complex of life-threating organ dysfunction in critically ill patients, with a primary infectious cause or through secondary infection of damaged tissues. The systemic consequences of sepsis have been intensively examined and evidences of local alterations and repercussions in the intestinal mucosal compartment is gradually defining gut-associated changes during sepsis. In the present review, we focus on sepsis-induced dysfunction of the intestinal barrier, consisting of an increased permeability of the epithelial lining, which may facilitate bacterial translocation. We discuss disturbances in intestinal vascular tonus and perfusion and coagulopathies with respect to their proposed underlying molecular mechanisms. The consequences of enzymatic responses by pancreatic proteases, intestinal alkaline phosphatases, and several matrix metalloproteases are also described. We conclude our insight with a discussion on novel therapeutic interventions derived from crucial aspects of the gut mucosal dynamics during sepsis.

Haussner F, Chakraborty S, Halbgebauer R, Huber-Lang M. Challenge to the Intestinal Mucosa During Sepsis. Front Immunol. 2019;10:891. Published 2019 Apr 30. doi:10.3389/fimmu.2019.00891.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502990/

Background: Smoking tobacco products remains a significant public health problem. The Foundation for a Smoke-Free World commissioned a 13-country survey to gain a clearer understanding of the current landscape of smoking behavior and preferences across the world.

Methods: Over 17,000 participants in 13 countries, representing different regions and income groups, answered questions on their smoking patterns and product use, their social context, their motivation to smoke, quit, or switch, and their perception of risks of products and substances. Rim weighting was done for each country to align responses with population demographics, and an additional 200 smokers for each country were surveyed to achieve sufficient sample size for sub-analyses of smoker data.

Results: The observed prevalence of smoking ranged from an age-adjusted high of 57.5% in Lebanon to 8.4% in New Zealand among men, with lower rates for women. The majority of smokers were between 25-54 years old, had daily routines and social patterns associated with smoking, used boxed cigarettes, and rated their health more poorly compared to never smokers. Among a range of products and substances, smokers tended to give both cigarettes and nicotine the highest harm ratings. Smokers in high income countries were largely familiar with electronic nicotine delivery systems; the most commonly given reasons for using them were to cut down or quit smoking. A majority of smokers had tried to quit at least once, and while many tried without assistance, motivations, intentions, and methods for smoking cessation, including professional help, nicotine replacement therapies or medications, or electronic cigarettes, varied among countries.

Conclusions: Smoking is deeply integrated in smokers’ lives worldwide. Although a majority of smokers have tried to quit, and are concerned for their health, they do not seek help. Smokers lack understanding of the harmful components of smoking tobacco products and the risk profile of alternatives.

Riahi F, Rajkumar S, Yach D. Tobacco smoking and nicotine delivery alternatives: patterns of product use and perceptions in 13 countries. F1000Res. 2019;8:80. Published 2019 May 13. doi:10.12688/f1000research.17635.2.

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introduction, Methods, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518446/

Scientific literature examining cannabis use in the context of health behaviors, such as exercise engagement, is extremely sparse and has yielded inconsistent findings. This issue is becoming increasingly relevant as cannabis legalization continues, a situation that has been associated with increased initiation of use among adults, and increased potency of available products in legalized states. Physical activity is among the most important health behaviors, but many Americans do not meet minimum exercise recommendations for healthy living. Common issues surrounding low exercise rates include inadequate enjoyment of and motivation to exercise, and poor recovery from exercise. It is unclear whether cannabis use shortly before and/or after exercise impacts these issues, and whether this co-use affects exercise performance. The present online survey study examines attitudes and behaviors regarding cannabis use with exercise among adult cannabis users living in states with full legal access (N = 605). Results indicated that the majority (81.7%) of participants endorsed using cannabis concurrently with exercise, and those who did tended to be younger and more likely to be males (p < 0.0005 for both). Even after controlling for these differences, co-users reported engaging in more minutes of aerobic and anaerobic exercise per week (p < 0.01 and p < 0.05, respectively). In addition, the majority of participants who endorsed using cannabis shortly before/after exercise reported that doing so enhances their enjoyment of and recovery from exercise, and approximately half reported that it increases their motivation to exercise. This study represents an important step in clarifying cannabis use with exercise among adult users in states with legal cannabis markets, and provides guidance for future research directions.

YorkWilliams SL, Gust CJ, Mueller R, et al. The New Runner's High? Examining Relationships Between Cannabis Use and Exercise Behavior in States With Legalized Cannabis. Front Public Health. 2019;7:99. Published 2019 Apr 30. doi:10.3389/fpubh.2019.00099.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503143/

Disparities exist in enrollment in clinical trials and biorepositories among adults with low socioeconomic status, racial and ethnic minority groups and individuals who live in rural areas. Diverse participation is necessary to identify the most effective treatments in different groups. The purpose of this study was to use qualitative methods to identify factors that may affect the likelihood that members of underrepresented groups choose to participate in clinical trials and/or biobanking. We conducted 14 focus groups and seven telephone interviews in urban and rural areas of Louisiana to: (1) identify barriers and facilitators to participation; and (2) elicit input in crafting clear, culturally appropriate language and recruitment strategies. Of 103 participants, 25 were safety-net healthcare providers, 18 were primary care or oncology clinic patients, and 60 were members of social and faith-based groups. Patients and community participants were English-speaking, 79% were African American, 81% were female and 24% lived in rural areas. Barriers to participation identified were lack of knowledge about clinical trials and biobanks; limited specific information and access to participation, trust and privacy concerns about clinical trials and biobanking Facilitators included: altruism, high interest in medical research particularly studies that might benefit them or their families; plain language, culturally appropriate information; convenient access to studies; and input of a trusted provider. In addition, all primary care providers were interested in having clinical trial options available for their patients but did not have time to search for available trials. Results of this study can inform the development of education materials and strategies to increase participation of underrepresented groups in clinical trial and biobanking.

Davis TC, Arnold CL, Mills G, Miele L. A Qualitative Study Exploring Barriers and Facilitators of Enrolling Underrepresented Populations in Clinical Trials and Biobanking. Front Cell Dev Biol. 2019;7:74. Published 2019 Apr 30. doi:10.3389/fcell.2019.00074.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, and Conclusion and Recommencations are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502895/

Studies have revealed conflicting results regarding the risk of cancer from alcohol consumption. Furthermore, some studies have suggested that wine may have benefits that separate it from other alcoholic beverages. As wine contains a significant amount of chemicals, specifically polyphenols like anthocyanins and proanthocyanidins (PA), that can affect cellular function and promote health, this hypothesis is reasonably supported by recent research. Polyphenols promote several anticancer cellular pathways, including xenobiotic metabolism, support of innate antioxidant production, and stimulation of phase I and II detoxification of carcinogens. However, the multitude of growing and production conditions of grapes, including temperature, water availability, soil type, maceration, and aging can result in a remarkably varying final product based on the available literature. Thus, we hypothesize that wines produced from grapes cultivated between steady daily temperatures at 15–25°C with moderate sun exposure from flowering to harvest, lower vine-water status, resulting either from lower precipitation, and irrigation practices or more permeable soil types, limitation of fertilizers, extended maceration, and aging in oak will impact the concentration of anthocyanins and PA in the finished wine and may have a differential impact on cancer. This higher concentration of polyphenols would, in theory, create a healthier wine, thus explaining the conflicting reports on the benefits or harms of wine.

Champ CE, Kundu-Champ A. Maximizing Polyphenol Content to Uncork the Relationship Between Wine and Cancer. Front Nutr. 2019;6:44. Published 2019 Apr 30. doi:10.3389/fnut.2019.00044

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Conclusion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502998/

Background: Numerous diets, apps and websites help guide and monitor dietary behaviour with the goal of losing weight, yet dieting success is highly dependent on personal preferences and circumstances. To enable a more quantitative approach to dieting, we developed an integrated platform that allows tracking of life-style information alongside molecular biofeedback measurements (lactate and insulin).

Methods: To facilitate weight loss, participants (≥18 years) omitted one main meal from the usual three-meal routine. Daily caloric intake was restricted to ~1200KCal with one optional snack ≤250KCal. A mobile health platform (personalhealth.warwick.ac.uk) was developed and used to maintain diaries of food intake, weight, urine collection and volume. A survey was conducted to understand participants’ willingness to collect samples, motivation for taking part in the study and reasons for dropout.

Results: Meal skipping resulted in weight loss after a 24 h period in contrast to 3-meal control days regardless of the meal that was skipped, breakfast, lunch or dinner (p < 0.001). Common reasons for engagement were interest in losing weight and personal metabolic profile. Total insulin and lactate values varied significantly between healthy and obese individuals at p = 0.01 and 0.05 respectively.

Conclusion: In a proof of concept study with a meal-skipping diet, we show that insulin and lactate values in urine correlate with weight loss, making these molecules potential candidates for quantitative feedback on food intake behaviour to people dieting.

Tejpal S, Sanghera N, Manoharan V, Planas-Iglesias J, Myler K, Klein-Seetharaman J. Towards personalised molecular feedback for weight loss. BMC Obes. 2019;6:20. Published 2019 May 6. doi:10.1186/s40608-019-0237-5.

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,unless otherwise stated.

Sections of the Abstract, Introduction, Discussion, and Conclusion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501287/

The most preferable mode of drugs administration is via the oral route but physiological barriers such as pH, enzymatic degradation etc. limit the absolute use of this route. Herein lies the importance of nanotechnology having a wide range of applications in the field of nano-medicine, particularly in drug delivery systems. The exclusive properties particularly small size and high surface area (which can be modified as required), exhibited by these nanoparticlesrender these structures more suitable for the purpose of drug delivery. Various nanostructures, like liposomes, dendrimers, mesoporous silica nanoparticles, etc. have been designed for the said purpose. These nanostructures have several advantages over traditional administration of medicine. Apart from overcoming the pharmacokinetic and pharmacodynamics limitations of many potential therapeutic molecules, they may also be useful for advanced drug delivery purposes like targeted drug delivery, controlled release, enhanced permeability and retention (EPR) effect. In this review, we attempt to describe an up-to-date knowledge on various strategically devised nanostructures to overcome the problems related to oral drug administration.

Ghosh S, Ghosh S, Sil PC. Role of nanostructures in improvising oral medicine. Toxicol Rep. 2019;6:358–368. Published 2019 Apr 15. doi:10.1016/j.toxrep.2019.04.004.

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Sections of the Abstract, Introduction, Oral Administration and Nanostructures, and Conclusion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502743/

Background: As schools of public health adapt to the new Council on Public Health (CEPH) competencies there is increased relevance in training public health professionals in public health entrepreneurship. Public health entrepreneurship provides an alternate process to traditional academic approaches focusing on translating public health knowledge into effective, sustainable, and scalable solutions.

Objective: This study reports student perceptions of public health entrepreneurship and training needs for successfully equipping future public health professionals.

Methods: Focus groups were conducted in April 2018 with graduate public health students in pilot entrepreneurship courses at two U.S.-based CEPH-accredited schools of public health.

Results: Participating students (n = 29) were mainly pursing MPH degrees (62%) within Health Management and Policy (38%) or Health Promotion/Global Health (31%) departments. Most students (52%) were between 21 and 30 years old. For 71% of students this was their first academic course with a focus on entrepreneurial thinking. Four themes emerged regarding public health entrepreneurship and training needs for becoming a successful public health professional of the future. Students confirmed a place for public health entrepreneurship in the emerging educational paradigm because it is action-oriented, skills-driven, and fosters innovation through inter-professional collaboration and cross-pollination of knowledge and skills between professional disciplines.

Conclusions: The competencies required for public health entrepreneurship are in alignment with CEPH competencies and are well-received by the next generation of public health professionals as an adjunct but nascent approach to stimulate public health innovation.

Becker ERB, Chahine T, Shegog R. Public Health Entrepreneurship: A Novel Path for Training Future Public Health Professionals. Front Public Health. 2019;7:89. Published 2019 Apr 24. doi:10.3389/fpubh.2019.00089

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499151/

Introduction: Many patients who were diagnosed as polycystic ovary syndrome- (PCOS-) related acne were not capable of sustaining or beginning oral contraceptive pills (OCPs) due to pill scaring, contraindications of OCP use, migraine, or smoking. In this situation, oral isotretinoin treatment may become an important option for PCOS-related acne. The aim of the study was to determine the effects of isotretinoin treatment on PCOS patients who were complicated with severe cystic acne.

Materials and Methods: This study consisted of 40 female patients diagnosed as PCOS complicated with severe cystic acne. These patients were not eligible candidates for OCP use due to migraine, thrombophilia, heavy smoking, or pill scare. To establish baseline values of hormone levels, on days 2–5 of the menstrual cycle, venous blood samples were obtained. Moreover Modified Ferriman-Gallwey (mFG) score, acne score (AS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment.

Results: Isotretinoin treatment significantly decreased Ferriman-Gallwey score, free testosterone, insulin level, hemoglobin level, acne score, and ovarian volume. Increased triglyceride and cholesterol levels were detected after treatment.

Conclusion: Isotretinoin treatment may have beneficial effects on free testosterone, insulin, acne score, and Ferriman-Gallwey score. Solely isotretinoin administration may supply adequate healing in PCOS patients' symptoms complicated with severe cystic acne who is not eligible candidates for OCP use. This trial is registered with Clinicaltrials.gov NCT02855138.

Acmaz G, Cınar L, Acmaz B, et al. The Effects of Oral Isotretinoin in Women with Acne and Polycystic Ovary Syndrome. Biomed Res Int. 2019;2019:2513067. Published 2019 Apr 7. doi:10.1155/2019/2513067

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introduction, Methods, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475563/

Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0.

Design: Repeated Cross Sectional Study.

Setting: United States.

Subjects: SSB consumption was estimated from 1–2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999–2006 National Health and Nutrition Examination Survey.

Methods: Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P).

Results: The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI: 1.6, 2.9) and the consumption of 124 more calories (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0.

Conclusions: SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women.

Gamba RJ, Leung CW, Petito L, Abrams B, Laraia BA. Sugar sweetened beverage consumption during pregnancy is associated with lower diet quality and greater total energy intake. PLoS One. 2019;14(4):e0215686. Published 2019 Apr 25. doi:10.1371/journal.pone.0215686.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, Methods, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483237/