Interesting video to think about

I like this video. Dr. Vincent Bellonzi delves into some of the underlying reasons we have a continued deficit when it comes to understanding preventive care.

Flu Vaccines

A recent meta-analysis in the Lancet (a meta-analysis combines the results of many studies and pools the data together providing a bigger picture of an area of interest) reviewed the effectiveness of vaccinations in all age groups. They found that 1.5 of every 100 adults vaccinated had a reduction in incidence of influenza A or B (the CDC usually places three strains either A or B in the flu vaccine).

The study showed no benefit for older adults (greater than 65) and that reported benefits are greatly reduced in some seasons (what season is that? flu season?). They did show the greatest benefit in young children. This can be due to many factors. One being reduced innate immunity due to a diet low in cholesterol, healthy fats, and sunlight exposure in addition to regularly consuming highly processed foods such as dairy, cereals, and grains. Cholesterol is a known factor the body uses to fight bacteria and viruses (in addition to other pathogens and toxins).

The risk associated with vaccines in any age group was not addressed. This includes immediate reactions and long-term harm associated with mercury accumulation.

The CDC states about vaccines,  

There are a number of factors that can make getting a good vaccine virus strain for vaccine production challenging, including both scientific issues and issues of timing. Currently, only viruses grown in eggs can be used as vaccine virus strains. If specimens have been grown in other cell lines, they cannot be used for vaccine strains. However, more and more laboratories do not use eggs to grow influenza viruses, making it difficult to obtain potential vaccine strains. In addition, some influenza viruses, like H3N2 viruses, grow poorly in eggs, making it even more difficult to obtain possible vaccine strains. In terms of timing, in some years certain influenza viruses may not circulate until later in the influenza season, or a virus can change late in the season or from one season to the next. This can make it difficult to forecast which viruses will predominate the following season, but it can also make it difficult to identify a vaccine virus strain in time for the production process to begin."

This combined with the fact that the overwhelming majority of reported "flu" episodes are not actually influenza A or B. CDC data indicates around 20% incidence rate. This greatly reduces the reported benefit of vaccinations.

I fail to see real benefit of the flu vaccination when there is so much we can do to improve our immunity and health through diet and lifestyle. I propose there is a much wiser and smarter alternative. This includes changes in diet, sunlight exposure, sleep patterns, exercise, and stress reduction. Prevention through lifestyle change can also have a widespread impact on our health in other areas (such as cancer, heart disease, and obesity) and may even prevent the flu in the first place. This may even help eliminate toxins accumulated over time (including mercury from previous vaccinations) improving longevity and quality of life issues.


Here is a summary of the findings from a study in the Journal of Virology. Healthy children that received preventive treatment in the form of regular flu vaccinations were shown to have less antibodies across a wider variety of flu strains than non-vaccinated children. This is classic and shows how short-sighted and poorly designed preventive treatment can present long-term risks on our ability fight disease and reduce stressors to our health. Keep in mind stress (inflammation) is good short-term to fight acute alterations in our homeostasis but inflammation associated with chronic stressors can have detrimental impact across many systems in our body.

Artificially acquired immunity (flu vaccinations) cannot and should not replace naturally acquired humoral immunity in diseases that pose little risk in healthy children. Children subject to regular flu vaccines are at higher risk for future viral infections than children who do not receive routine influenza vaccinations. There are much better ways to upregulate innate and adaptive immunity. This should be the focus of carefully designed preventive treatment.


There is no magic pill (or shot) to cure or prevent our ails. Do you really want an injection filled toxins that slowly reduces your immune response year after year? The choice is yours.

Is endurance exercise a healthy or a risky behavior?

Cardiac troponin I (CTI), a cardiac enzyme, is a reliable biomarker for heart damage. It is a protein that regulates the contractility of the heart and moderates calcium interaction with myocin and actin in the heart muscle. Actin and myocin work together in the production and utilization of energy in the heart muscles. When these fibers (actin) and protein (myocin which is used in cellular energy production) get damaged CTI increases. CTI is used to determine how much damage is occurring in the heart or how much the heart is being deprived of oxygen. Here is a great article that provides a nice benefit/risk analysis.

Yes, endurance exercise such as running, cycling, rowing, hiking, or any strenuous activity lasting mroe than 3 hours deprives the heart of oxygen, damages the heart muscles, and places an individual at higher risk for a heart attack during and for a period of time after strenuous activity.

Anytime your CTI is elevated, this places you at risk for cardiovascular attack. One study showed an increase of 34 % CTI in marathon runners.

Try HIIT  instead. It stimulates latent human growth hormone while increasing cardiac reserve, lung capacity and lowering your risk for your cardiovascular disease without the associated risks of chronic aerobic activity.

A Tidbit on Nursing and Theories

Nursing theory is invaluable to application of practice. What theory a nurse adheres to is not as important as thoughtful consideration of practice and incorporation of the theory. The benefits of theory application are observed in treatment outcomes and thinking processes (McEwen & Wills, 2011). Theories use principles of reasoning that define our practice through structured models, systematic explanation, and evidenced-based research.

Currently, I am incorporating scientific research rarely defined by nursing theory into my understanding of health and wellness. I do not prescribe to any specific theory and pull from most theories to some extent. As a nurse seeking to understand how to improve my health and reduce all risk factors associated with morbidity and mortality, the general systems theory, adaptation theory, and developmental theory (Nursing Theories, 2011) all play into my understanding of the complex mechanisms of homeostasis, intra/intercellular communication, and the external influences that direct health outcomes.

The general systems theory seeks to define the whole person into compartmentalized parts and then explain how these parts interact and influence the whole person (Nursing Theories, 2011). One area I am currently studying is cardiovascular disease. This theory is critical in understanding how specific parts of the whole like cholesterol and cytokines are influenced by bodily responses to intake and how these responses impact systemic immunity, cardiovascular disease, and cancer.

Adaptation theory explains how we adapt and our body evolves and changes through hormesis or becomes damaged by mutagenic forces. It also describes how we interact and respond psychologically both socially and personally to external and internal influences (Nursing Theories, 2011).

Developmental theory seeks to explain how we as people go through stages physically, mentally, socially, and emotionally and how these factors influence our quality of life, decisions, and perspectives (Nursing Theories, 2011).

Finding how a theory or theories fit into our professional practice is a natural outcome of personal exploration by seeking to understand ourselves, our profession, and the world around us. Applying scientific theory that explains the influences of our behaviors, health, and values will help us to continue to grow as professional and people while we contribute to the world around us.

References

McEwen, M. and Wills, E. (2011). Theoretical Basis for Nursing. [3^rd ed.]. Philadelphia, PA: Wolters, Kluwer/Lippincott, William, and Wilkins

Nursing Theories: An Overview, (2011). Retrieved December 9, 2011 from http://currentnursing.com/nursing_theory/nursing_theories_overview.html

What are Cytokines?

Cytokines are proteins that signal cells to act throughout the body. They are inflammatory in nature and are classified as proteins, peptides, and polypeptides (a nice pictorial of cellular immunity at work). One commonly known cytokine, interferon type I is used to treat hepatitis B and C.


There is debate in the scientific community whether or not cytokines are hormones. This may be due in part to their anatomy, origin, and level of concentration in the body. Cytokines can be concentrated 1,000s times greater during trauma or infection. Hormones are generally secreted by localized organs/glands such as the pancreas while cytokines can be generated from nearly every nucleated cell in our body including macrophages (WBCs), endothelial cells (interior of our body) like those that line our blood vessels, and epithelial cells (surface of our body) like our skin.


Here is a video representation courtesy of nucleusinc.org:

Just thinking about the structure of cytokines brings to light the fact that they are all highly dependent upon adequate levels of cholesterol since cell membrane structural integrity and intracellular communication are all reliant on cholesterol. In addition, WBCs act immunoprotectively with cholesterol in the blood to bind to and inactivate toxins such as bacteria, viruses, fungi, and free radicals. Here is a good site with practical application tips to reduce inflammation while enhancing the body's immunoprotective abilities naturally without dependence drugs which are partly responsible for iatrogenic disease and death. This also highlights one way cholesterol plays a role in immunity and how it may relate to other diseases such as cancer (McCully, Ravnskov & Rosch, 2011).  

Cytokines are active in both acute and chronic inflammation. This is a two edged sword since they actively facilitate immune responses in our body. Chronic inflammation can have detrimental long-term impact on our health and should be minimized since inflammation is a contributory factor in cardiovascular disease. This may be how statins are protective by reducing C-reactive protein (CRP) an inflammatory marker, needless to say the harm associated with statin's cholesterol lowering effect is greater than its documented benefits.

There are many factors that stimulate chronic inflammation and this is the underlying issue we should seek to correct when considering any level of prevention. Addressing these health abnormalities through a symptomatic response (pharmaceuticals) can have untold long-term consequences including cancer.

The greatest benefit of acute inflammation occurs when we have an infection. Inflammation stimulates cholesterol production. The bad news is that as chronic inflammation continues it inhibits nitric oxide (NO), a potent vasodilator, increases blood pressure and places the lining of our blood vessels at increased risk through atherosclerosis. The mechanisms responsible for atherosclerosis are very complex and the presence of cholesterol does not necessarily indicate cause. One of statins' benefits comes from inflammation reduction. According to Chris Masterjohn, (he describes the process in great detail here), statins can provide a co-occurring negative impact by reducing Coenzyme Q10 production which works in conjunction to NO to improve cardiovascular function and negate the effects of atherosclerosis. Statins are also known to cause muscle degeneration. Think about your heart. It is a muscle.


We need cytokines to keep us healthy when we get sick. We also need to understand how chronic inflammation occurs and to moderate the its effects by our lifestyle choices. When trying to mitigate these risks, understanding what causes inflammation and how to prevent it can reduce the risk of health problems down the road. We should approach it though our diet and lifestyle not a drug . . . unless you want to take that risk.


References

McCully, K., Ravnskov, U., and Rosch, P. (2011). The statin-low cholesterol-cancer conundrum. Quarterly Journal of Medicine. doi: 10.1093/qjmed/hcr243

Gender Bias In Nursing Education

Nursing education delivery systems are crucial not only for producing competent and inquisitive nurses, they are also important for delivering quality content unencumbered by the influence of a profession dominated by a particular culture. Currently, males are 5.8 percent of the nursing population (Bell-Scriber, 2008). Upon graduation, in a class averaging 40 nursing students, approximately two males enter the nursing field, even though five to seven may have initially started the program. Many factors within educational processes contribute to an environment that diminishes continued interest and an attrition rate higher in males than females. Nursing education is experiencing an ongoing staffing shortage (Barker, 2009) with some colleges retaining no male faculty even though efforts are ongoing; encouraging males to enter a career in nursing poses many challenges (AACN, 2011). The inability to incorporate competent male nurses willing to matriculate into nursing faculty is of particular interest. The projected nursing shortage is magnified by the nursing faculty shortage. Not surprisingly, male faculty may provide opportunity for needed changes in the teaching process in order to create a more positive learning environment for male and other minority nursing students. Pursuing an advance nursing degree in nursing education as a male, this area of cultural weakness is of particular interest. While in nursing school, my mentor was a male psychiatric instructor. He continues to this day functioning as a mentor providing significant inspiration and guidance in my career decisions and educational goals. Male mentors especially in education are unique, rare, and hold special value. This paper reviews some of the processes associated with cultural bias negatively impacting male learners in nursing education. However unintended, this cultural bias is a normal phenomena inherent to any institution dominated by one segment of persons (Bell-Scriber, 2008).

Summary of Article

            The article, Warming the nursing education climate for traditional-age learners who are male, (Bell-Scriber, 2008) describes some of the various mechanisms that contribute to an environment resulting in higher attrition among traditional-age (18-23) males. It highlights the limited amount of research and programs designed to understand the problem and facilitate retention. Surprisingly, some of the factors attributed to hold the most significance impairing male students exist within the environment designed to educate and train nurses for readiness in the profession. One barrier to success includes the paucity of available male mentors. This is underscored by the core influencing hindering factor: nurse instructors’ attitudes and behaviors that have been demonstrated to be characteristically unsupportive (Bell-Scriber, 2008). Bell-Scriber also notes that nurse instructors, overwhelmingly female, are frequently unaware of the needs and triggers that stimulate frustration and stress in the male student. Males have also expressed perceived discrimination in the clinical setting although this is generally bias influenced by perceived role identity within settings such as labor and delivery and pediatrics.

            The belief that a woman and a man are equal in skills and outcomes reveal a direct contrast when both sexes develop opposing experiences and perspectives about the learning environment and process associated information differently. Apparently, the number of years an instructor teaches does not play a role when perceiving influences that affect learning. Many factors play into this and more research underpinning educators’ influence regarding students’ ability to learn is clearly indicated.

Themes Influencing Climate

            There were five themes generated from the study: 1) Nurse educators’ behaviors and characteristics; Micro-inequalities inherent in instruction delivery. Subtleties such as conversive terseness, body language, gestures, tone, inferring a diminutive attitude toward male learners feelings and thoughts, and absence of interaction all relay an atmosphere that erodes the learning climate. It was noted that nurse educators often fail to understand male students and perceive their behaviors as lazy. Female learners on the other hand were perceived as more nurturing and caring endearing stronger support from their instructors. 2) Meaningful experiences; all male learners described meaningful experiences occurred away from their instructors with their patients while most females described experiences occurring with their instructor as meaningful. 3) Peers’ behaviors and characteristics; Male learners experienced support from their peers as a prospective nurse while some of their instructors questioned their motivations. 4) Education environmental factors; Classroom size inhibited interaction due to males fearing being focused on when asking questions. Textbooks showed a strong disparity using females as examples while omitting males. The use of the terms her and she where noted as universal in some textbooks and handouts. In addition to these influences, male learners noticed their continued diminishing population, which enhanced other negative climate variables. 5) External environmental factors; Men often experienced inadequate social support from their peer group, family, and friends. They were sometimes teased or their intentions questioned. This was known to have a stifling effect (Bell-Scriber, 2008). 

Application to Practice

According to the National League for Nursing (Adams et. al, 2005), a core competency of nurse educators should be the ability to develop an environment that is conducive to learning for all students regardless of cultural variable including age, sex, and minority status. Traditional-age males are no exception. Nontraditional-age males do not experience the same difficulties as their life experience and coping abilities have evolved better equipping them to overcome perceived challenges noted by traditional-age male learners (Bell-Scriber, 2008). There are many strategies to consider in addressing this educational challenge. Nurse educators can be encouraged to allow for outside observers or culturally aware colleagues to evaluate their educational delivery methods via direct observation, video, or audio recording. Other strategies could include incorporating assessment rubrics for prospective nurse educators as a part of the hiring process. A continuous plan of action could also be incorporated in the workplace raising awareness of bias and climate indicators that inhibit success for all minority classes. Cohort relationships can also carry strong importance though the student learner process. Developing methods to encourage healthy male-female relationships within student populations can foster friendships, socialization, and camaraderie that may extend far beyond nursing school. This socialization process has been shown to help diminish stress affiliated with male learners (Bell-Scriber, 2008). Addressing these issues proactively can help reduce the projected nursing shortage expected to grow in the next 20 years both in the in field and education institutions (Barker, 2009).

Conclusion

Understanding the circumstances unique to the male learner is critical to nursing education. How nursing instructors construct their message, encourage interaction, foster relationships is dependent upon identification of the needs of their learners. The nurse educator holds the experience of their students’ learning in their hands. Creating a climate that meets the needs of the male learner can further encourage altruistic purpose and enhance the understanding of nursing in the minds of men. It is true; men are traditionally considering ways to increase income through the field of nursing. By igniting awareness in the delivery process, educators can contribute significant depth and width to male learners understanding. The efforts nurse educators make in delivering meaningful and rewarding education should be more readily understood and appreciated by male learners. In doing so, educators can help develop traits in male learners that may foster an increased interest in delivering those same learned rewards to other prospective nurses.

References

AACN, (2011). Financial Aid. American Association of Colleges of Nursing. Retrieved December 6, 2011 from www.aacn.nche.edu/students/financial-aid

Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.

Bell-Scriber, M. (2008). Nursing Education Research: Warming the nursing climate for traditional-age learners who are male. Nursing Education Perspective. 29(3), May/June:143-150. Retrieved December 6, 2011 from http://ovidsp.tx.ovid.com.library.gcu.edu

Adams, C., Aucoin, J., Lindell, D., Connolly, M., Devaney, S., Love, A., Ortelli, T., Sharts-Hopko, N., Timmons, M., Zhan, L. (2005). The Scope of Practice for Academic Nurse Educators. National League for Nursing. Retrieved December 7, 2011 from www.nln.org/publications/scope/index.htm

Low sodium intake is associated with heart disease

A recent study in Canada examined the sodium and potassium intake of 28,800 participants in two large studies spanning a seven year period. They measures average excretion rates which is one way to determine intake as noted by a fairly high accuracy rate from this study.

The healthiest sodium intake was between 4 to 6 grams. Those who consumed lower or much higher amounts had higher incidence of death from heart attacks and strokes. I have not seen any randomized studies providing definitive proof that a low sodium diet reduces heart attack and stroke rates. The current science seems to indicate a moderate intake of sodium for improved cardiovascular health is best.

This is in stark contrast with current government recommendations which are as follows:

• AI (adequate intake) is 1.5 grams
• Maximum intake is 2.3 grams

Both of these government recommended daily allowance references place the public at increased risk for heart attack and stroke. No wonder cardiovascular disease is the per-eminent killer in America just behind iatrogenic causes. Reducing sodium too much is dangerous and ineffective for controlling blood pressure as demonstrated by this metaanalysis due to increased renin secretion (raising blood pressure) and sodium depletion (which causes a sympathetic response). The study also showed that moderate sodium intake of 4.6 grams (within a healthy range) did have a positive impact on blood pressure.

This, in addition to other factors may be why sodium intake higher than government guidelines is good for you. Sodium has many roles in our body. Perhaps the most well known is the sodium potassium pump (SPP). This is what helps maintain our blood pressure and contractility. Every muscle is dependent upon proper function of the SPP in order to work effectively, especially your heart.

We shouldn't be afraid of sodium. We should be afraid of the processed foods that abuse sodium placing us at risk. Eating a healthy diet composes of whole, unprocessed foods and flavoring to taste with healthier versions of salt (like Himalayan or sea salt) and other healthy spices like cumin, cayenne, curry, and cinnamon are much wiser choices.

Cholesterol, Immunity, and Infectious Disease

Cholesterol plays an important role in immunity, especially with bloodborne pathogens. One study here explained that total cholesterol (TC) fluctuates wildly during acute infections indicating cholesterol may have immune mediated activity. The article reviewed 19 cohort studies that revealed a correlation between increased death from respiratory and gastrointestinal diseases (both infectious) and low TC.

It also showed that people admitted to hospitals due to an infectious disease also had low cholesterol. Some common diseases noted were genitourinary infections, skin, and subcutaneous (just below the skin) infections. HIV and death from AIDS were also associated with lower cholesterol levels.

Patients with low TC suffering from chronic heart failure had a poorer prognosis after surgery and lower long-term survival rates. This also included patients recovering from abdominal surgeries. Another interesting note was that people suffering from hepatitis B including asymptomatic carriers also have lower TC levels.

Although the evidence shows that young and middle-aged men are at risk for heart disease with high cholesterol (this can be controlled through diet) their risk becomes negated when they get close to 50. As one gets older, higher cholesterol is associated with longevity 1, 2 in both men and women. This may be due to not only the cardioprotective effects of higher cholesterol but also to innate immunoprotective mechanisms associated higher TC.

Interestingly, eating a diet lower in fiber increases serum cholesterol due to the gut's increased ability to reabsorb cholesterol in the absence of fiber. In addition to this, diets higher in linoleic and linolenic acids (essential fatty acids) may help prevent or reverse atherosclerosis (yes, atherosclerosis can be reversed).

Another article showed that one cause of cardiovascular disease may result from bacterial communities reinfecting arterial walls. Suppressed immune response related to low cholesterol may be a contributing factor.

If you want to reduce your risk of infection and improve immunity response mechanisms, one thing to consider is maintaining healthy cholesterol levels. Cholesterol may also play a role in a number of autoimmune disorders.

Interview with a Friend

It is my sincere desire to challenge nurses (or anyone for that matter) to pick up the gauntlet, better yourself, and the world around you through life-long learning. Be it through higher education or just a spirit of inquisitiveness. Be willing to explore the world beyond the boundaries of your experience. Now, on with the interview . . . 

 

Trying to realize what a master’s degree in nursing education (MSN Ed) means cannot be realized through reading a book, attending courses, or landing a first position. An MSN Ed is an artful practice. In this design, passion flows from the culmination of experience, challenges, and relationships. Graduating with an associate of science degree in nursing (ASN) in December 2003, my psychiatric professor and first mentor guided me to my first and present position. Finding a niche, growing by leaps and bounds as a nurse, family member, and citizen, returning to college was the next logical step. Fast forward to my first MSN Ed assignment. After driving to my alma mater and seeking a willing interviewee, to my surprise standing in the nursing department's hallway was my mentor and psychiatric professor. He offered graciously to be interviewed as we caught up on lost time. Below is his perspective of a master’s prepared nurse educator including his career development, purpose of education, current position, and pearls of wisdom.

Overview of Career

The most significant thing that prepared him for his career as an educator was his experience as a registered nurse. He spent more than 12 years in psychiatric nursing (PN), describing succinctly that PN is more than understanding the difference between schizophrenia and bipolar disorder, handing out pills, or control psychotic symptoms. PN is effective communication, patient trust and rapport, guiding leadership, and modeling healthy behaviors that foster recovery and mental health. Wanting to enhance his career, he returned to school.

Graduate Education

Getting his MSN opened doors he never knew were possible. The opportunity to be a college instructor took his career in an important direction. He developed a passion as an educator that continues to this day and still aspires higher levels of education and career opportunities. The original reason he sought graduate education was to be able to move into management and administrative positions in quality improvement. An underlying motivating factor was financial gain. Over time, his motivations and goals started to shift. Personal satisfaction stemming from spontaneous altruistic outcroppings began to take hold. The palatability of earlier motivations subsided in an atmosphere of sharing knowledge and giving to others. Currently, he is pursuing a doctorate in education and continues to give his time, insight, and perspective to others. It is clear that his experience as a graduate nurse has been both enriching and enlightening.

Present Position

Graduate education has provided many opportunities that were not available in his undergraduate years. He is now functioning as Assistant Director of Nursing at my alma mater. He also is an adjunct faculty member at the following institutions: Roseman University (formerly University of Southern Nevada), Southwestern College, University of Phoenix, and other seasonal positions.  He spent three years co-directing the California Nurse Mentorship Project, which lead to other contacts in education, new opportunities, and experiences. Perhaps the most exciting part of his educational journey is the fact that there is another mountain to climb on the horizon. Career-wise, he is confident the future will be even more fulfilling. An interesting point was learning how principles of graduate nursing are applied to his leadership role as Assistant Director of Nursing. Integrating theory into practice and applying it through instruction to nursing students demonstrates the complex and compelling amalgam that is nursing education.

Pearls of Wisdom

First and foremost,  realize the importance of fostering relationships made along your journey as nurse. These relationships are very important and may open doors in the future. Secondly, be willing to go outside your comfort zone and take risks. Venturing into the unknown always provides benefit even in the light of the occasional misstep. One of the greatest mistakes he made was leaving the college he is currently employed for another (seemingly more appealing) teaching position.  He eventually returned to the college he left and remains to this day. In light of this, he learned a valuable personal lesson and developed more professional relationships. Taking risks carries a caveat. Sometimes we fail. Even in failure we gain wisdom and grow as a person. Success and failure are parallel paradigms in our journey and what we learn through both is equally important.

Conclusion

In summary, my psychiatric nursing instructor has not only played a significant role in my early career decisions, now more than ever he continues to guide me in ways not yet realized. There is also the renewed appreciation of a genuine professional and friend. My mentor holds close to his belt competencies that are consistent with the American Association of Colleges of Nursing (AACN). Here is a short list quickly observed through our brief discussion that applies the AACN Essentials of Master’s Education in Nursing (AACN, 2011): flexible leadership as observed by historical roles and current leadership positions; advancing personal excellence through lifelong learning; application of research into practice; and most importantly, sharing through mentoring and guidance continued learning as it applies to nurses at a higher level of practice. This was more than just an assignment. It was an inspirational moment that showed the value and life enriching experience associated with continued excellence in education. It also shows how nurses can positively influence the lives and careers of their colleagues.

References

AACN, (2004). AACN Postion Statement on the Practice Doctorate in Nursing, October 2004. American College of Association of Nurses. Retrieved November 21, 2011 from www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf

AACN, (2011). The Essentials of Master’s Education in Nursing. American Association of Colleges of Nursing. Retrieved November 28, 2011 from www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.

Low Total Cholesterol and Mortality Rates

This is an exploration of mortality rates associated with low cholesterol. The review was published in Circulation: Journal of the American Heart Association. In this review, the National Heart, Lung, and Blood Institute held a conference seeking to understand why lower total cholesterol (TC) levels are associated with some cancers, respiratory and digestive diseases, trauma, and residual deaths.

Apparently, men are more susceptible to this correlation than women. They examined 19 cohort studies from the U.S., Europe, Israel, and Japan. TC is a calculation of cholesterol measurements of LDL, HDL, and triglycerides.  The review noted high rates of cerebral hemorrhage with lower average TC. The rate of cerebral hemorrhage decreased as average TC went up in prospective populations. This was true in the Multiple Risk Factor Intervention Trial (MRFIT) in addition to increased incidence of colon cancer with lower TC. This may be related to what I wrote in an earlier post.

For women, 6 of the 11 studies showed no variation in cancer death rates across all spectrum of TC levels. There was an increased cancer risk in men when their TC levels fell below 180 mg/dL. In non-cancer and non-cardiovascular death rates, both men and women had similar risk findings. When TC was below 160 mg/dL there was a 40% increase of mortality compared to 160-199 mg/dL levels. Risk was also reduced by 10% when TC levels were between 200-240 mg/dL compared to the reference class (TC between 160-199 mg/dL levels).

This increase in non-cardiovascular deaths raises the issue of the dangers associated with taking cholesterol lowering drugs. These dangers are real and should not be taken likely (as mentioned in the study). Once again, when the data was pooled together, TC below 160 mg/dL was associated with highest risk of mortality.

Unfortunately, some of the data did not differentiate between age or sex but we can assume that having TC this low for anyone is quite risky. The review did take into account people with diabetes, smokers, CVD, alcohol intake, and other possible factors that might skew the data. Some of the research also separated participants further by age and gender.

Findings for all-cause mortality (ACM [death from any cause]) for those with TC between 200-240 mg/dL had the lowest incidence. The rate of death increased the TC went down below 199 mg/dL (are you seeing a trend yet?). Interestingly enough, the American Heart Association, the journal's parent organization, say that total cholesterol should be below 200 mg/dL. This is the range that has been demonstrated by the AHA to increase risk death from all causes. The standard protocol for primary care providers is to prescribe statin medication when TC is above 200 mg/dL which will place patients well within the range of increased risk of death. 

There are also other health risks associated with direct effect of statin use in addition to health benefits not associated with TC lowering mechanisms. Statins act on many mechanisms in addition to reducing cholesterol synthesis in the liver. A benefit-risk analysis of statin use will be explored in a future post.

It is safe to say that total cholesterol levels appear safest when they remain in the range between 200-240 mg/dL. This is my target. Unless you have a very rare disease, it is completely controllable through diet which will be discussed later. Don't forget exercise will increase your total cholesterol level (by increasing HDL) as it improves your health.

The AACN, an Umbrella Organization

As I have mentioned before, I am getting an advanced education in nursing right now so some of my posts will be directly related to my studies and things I am learning. Most of the nursing posts over the next two years will be written from this perspective. So, here is one about a professional nursing organization that may end up being critical to the development of nursing as a profession. 

To my surprise, there are at least 113 national nursing organizations and 140 state nursing organizations. There are also international nursing organizations such as Nurses of Emergency and International Society of Psychiatric Mental Health. When I had to select one to write about, needless to say I was overwhelmed. A cursory review of these organizations (NP Central, 2003) reveal an absence of my interest spectrum, which emphasizes beneficent outcomes related to treatment modalities central to nutritional intake through gut-brain axis mechanisms. Perhaps another professional organization is in order. Until that happens, I decided to look more closely at the American Association of Colleges of Nursing (AACN). Many of the organizations listed on NP Central’s website hold goals that fall under the umbrella of the AANC's purview. The AACN has a national goal of synthesizing nursing professional structure and development as a whole.

The AACN is special in the sense that its vision for the future, specifically by 2020 is to develop consistently educated and trained professional nurses across the country trained to lead improved healthcare delivery methods. By establishing collaborative relationships and alliances with educational institutions nationally, the AACN hopes to influence member school's processes associated with education, research, and clinical practice (AACN, 2011). In doing so, the AACN can function as a nationally accepted primary source of advanced nursing education through policy, initiatives, and programs designed to propel nursing professionals to the forefront of healthcare and in their profession (AACN, 2011). 

The AACN describes organizational values that are open and responsive the interest of their stakeholders (AACN, 2011). Their priorities and goals may contribute dramatically to the final emergence of nursing as a profession. Their comprehensive grasp of nursing’s strengths, weaknesses, and potential contributions to society should benefit all practicing nurses, especially the upcoming generation of advance-practice nurses. Understanding the goals and aspirations of the AACN, nurses can incorporate a similar philosophy within their practice connecting them literally to the evolution of nursing from an occupation to a profession. I am personally going to incorporate their perspective with my own goals and encourage fellow nurses to help advance their practice through education and learning. Only by continuing our interaction and taking advantage of learning opportunities such as those provided by nursing and non-nursing organizations can the advancement of nursing progress.

References 

AACN, (2011). Mission and Values. American Association of Colleges of Nursing. Retrieved November 27, 2011 from http://www.aacn.nche.edu/about-aacn/mission-values

NP Central, (2003). Nursing Organization Links: National Nursing Organizations, State Nursing Organization, International Nursing Organizations. Retrieved November 27, 2011 from http://www.nurse.org/orgs.shtml

BSN vs. MSN

Baccalaureate nursing education comprises a foundational degree that prepares the nurse to incorporate evidenced-based research into practice, apply skills in leadership roles, and identify specific treatment needs that may be unique to individuals or generalized to select communities (AACN, 2008). According to the AACN, there are nine essentials to the undergraduate nursing baccalaureate degree that encompass an interdisciplinary approached facilitating care delivery through articulate communication, improved quality of care, and management of healthcare delivery systems. The focus of undergraduate nursing education is nonspecific to specialty yet prepares nurses for ensuing professional challenges both in the workplace and with future educational aspirations.

Graduate degree nursing is more precise in expected outcomes yet more dynamic in role application through degree specialty with greater emphasis on nursing’s transition from an occupation to a profession as defined by (McEwen & Wills, 2011). One distinction between baccalaureate and master’s education is the broad contributory effect to social, business, education, politics, and healthcare science and application (AACN, 1996) intrinsic in advanced practice nursing. These contributions flow primarily from an emphasis on clinical expertise in selected specialties such as nurse anesthetist, nurse practitioner, clinical nurse specialist, and nurse mid-wife although non-clinical specialties such as nurse educator and administration are also included.

My graduate nursing expectations are influenced by personal desire to change roles from a level of care nurse in a psychiatric setting to a more research-based, consulting, and educational role. It should prepare me to continue lifelong learning appropriate to my clinical specialty or theoretical role. Currently, being a nurse educator is one of my interests, thus the specialty of my current degree. There are other more personal family factors influencing this decision. I also want to understand and apply primary and secondary prevention without the necessary use of conventional medical protocols. My desire is to understand and facilitate the body’s natural healing mechanisms through nutritional and biologic processes. One of the practical applications that master’s prepared nurses engage is (and I believe it is the most important process) providing interventions through the therapeutic use of self (McEwen & Wills, 2011). I have and continue to conduct n=1 research projects and hope to supplement this anecdotal knowledge to research-based efforts in the beneficence of others. This may require a nurse practitioner degree so my current graduate nursing expectations are still in flux and remain fluid.

References

AACN, (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. American Association of College of Nursing. Retrieved November 25, 2011 from www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf

AACN, (1996). The Essentials of Master's Education for Advanced Practice Nursing. American Association of College of Nursing.  Retrieved November 25, 2011 from www.aacn.nche.edu/Education/pdf/MasEssentials96.pdf

McEwen, M. and Wills, E. (2011). Theoretical Basis for Nursing. [3^rd ed.]. Philadelphia, PA: Wolters, Kluwer/Lippincott, William, and Wilkins

Talk about Longevity . . .

A woman living in the western Brazilian Amazon, Maria Lucimar Pereira, recently celebrated her 121st birthday. She has never lived in a city and is rooted strongly in her local culture.

Some of her pearls of wisdom: 

• I don't eat junk food
• I mind my own business

What is her usual diet? Well, she only eats unprocessed local foods:

• Fresh fish
• Banana porridge
• Root vegetables (manioc)
• Grilled meat
• Monkey
• She also avoids salt, sugar and processed foods

Another interesting point she made in her interview is that she walks regularly in her village visiting friends and relatives and does not use soap or any artificial products from the city.

Dare I say, this appears to be a very organic lifestyle.

Advanced Practice Nursing

Recently starting my MSN Ed, I quickly realized there is a newer and larger definition of advanced practice nursing or advanced nursing practice. I'll just call it APN. Historically, APN stood for advanced clinically trained nurses in direct patient care such as nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse-midwives.

The current trending definition of APN includes all master's and doctorate level educated nurses. According to the (AACN, 2004),

Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.

This modern definition of APN includes nurse educators, public health nurses, nurse administrators, and nursing research. I was surprised to learn APNs are no longer limited to direct clinical care. As far as mandating doctorate level education to the definition of APN, direct clinical care (DNP) and nursing research (PhD) seem to be the only two defined terminal pathways.

The exceptions to the current proposed mandate of doctorate level educated nurses by 2015 appear to be limited to clinical nurse leaders and nurse educators. These two professional arenas are generally accepted at the master's level due to the combination of didactic training and practical experience (Barker, 2009).

References

AACN, (2004). AACN Postion Statement on the Practice Doctorate in Nursing, October 2004. American College of Association of Nurses. Retrieved November 21, 2011 from www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf

Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.

Interesting theory on Melanoma

I recently read an article proposing an alternative theory to increased incidence of melanoma. It isn't what I expected. Basically it argues that people working indoors have a higher incidence (up to 9 times more) than people working outdoors.

Here is the abstract from Medical Hypothesis at Elsevier:

Cutaneous malignant melanoma (CMM) has been increasing at a steady exponential rate in fair-skinned, indoor workers since before 1940. A paradox exists between indoor and outdoor workers because indoor workers get three to nine times less solar UV (290–400 nm) exposure than outdoor workers get, yet only indoor workers have an increasing incidence of CMM. Thus, another “factor(s)” is/are involved that increases the CMM risk for indoor workers. We hypothesize that one factor involves indoor exposures to UVA (321–400 nm) passing through windows, which can cause mutations and can break down vitamin D₃ formed after outdoor UVB (290–320 nm) exposure, and the other factor involves low levels of cutaneous vitamin D₃. After vitamin D₃ forms, melanoma cells can convert it to the hormone, 1,25-dihydroxyvitamin D₃, or calcitriol, which causes growth inhibition and apoptotic cell death in vitro and in vivo. We measured the outdoor and indoor solar irradiances and found indoor solar UVA irradiances represent about 25% (or 5–10 W/m²) of the outdoor irradiances and are about 60 times greater than fluorescent light irradiances. We calculated the outdoor and indoor UV contributions toward different biological endpoints by weighting the emission spectra by the action spectra: erythema, squamous cell carcinoma, melanoma (fish), and previtamin D₃. Furthermore, we found production of previtamin D₃ only occurs outside where there is enough UVB. We agree that intense, intermittent outdoor UV overexposures and sunburns initiate CMM; we now propose that increased UVA exposures and inadequately maintained cutaneous levels of vitamin D₃ promotes CMM.

Since UVB sunlight exposure of 15-30 minutes can produce between 15,000 to 30,000 IU of vitamin D3 which is protective against melanoma. We should get outside more frequently. Protect your face and neck with a hat (since this is the most susceptable area of the body due to chronic, long-term exposure), and get an adequate dose of sunlight on a regular basis. DO NOT put on sunscreen when you want to get vitamin D since it blocks UVB exposure of the skin and subsequently vitamin D synthesis.

Vitamin D has been found to act on approximately 2,000 genes in our body and every single cell has at least one vitamin D sensitive receptor/activator in the phospholipid bilayer (cell wall) as noted in ScienceDaily. Think about what that can mean for a moment. Do we really want to be deficient with this hormone? Yes, vitamin D is not a vitamin. It is a hormone that has action in our endocrine system regulating more than we realize. Since vitamin D is one of my personal pet study projects, I plan to study it further.

Ode to the Cow

Okay. Here's a controversial one. . . what happened to our milk? A larger and more salient question concerning our diet, nutrition, and physical health may be what happened to our food supply? Let's look at dairy products.

Dairy, glistening milk, savory butter, thick cream, and satiating cheese. How about the cultured variety, yogurt and keifer? Then, there are fermented curds and whey and don't forget cottage cheese. I eat dairy raw as much as possible with the exception of the occasional heavy whipping cream dosed for my Starbuck's coffee. Did you know that you can leave raw milk out on the counter for three days, consume it, and gain health benefits? I didn't until a few months ago when I learned how to make homemade cottage cheese. The separated whey can be used for fermenting vegetables like sauerkraut.

Why do the vast majority of us avoid raw dairy? Is it because milk has undergone demonization by the dairy industry, FDA, and other authoritative entities under the premise of public health? Is it really that dangerous? Maybe we should ask the Masai tribe. There is plenty of research on these people consuming large amounts raw milk and meat "with little or no evidence of atherosclerosis or heart disease". However one chooses to view this controversy, changing the way humans have consumed dairy for tens of thousands of years has a causal relationship wtih our health.

Milk consumption has undergone dramatic changes in composition and production in the last 200 years. We have moved from milking our own cows and goats to strict oversight of production from the feeding of cattle to dispensing at the store front. Current mechanisms of dairy mass-production may very well be antiquated and more hazardous to our health than consuming raw and unprocessed dairy from small family farms. Yes, one can drink contaminated milk (raw or processed) and get acutely ill. The media coverage is enough to scare anyone into thinking raw milk is akin to poison. Just review the recent news about FDA approved monitored food products 1, 2, 3 and see the inherent dangers associated with governmental regulation of food products in general. A lot of this is new to me and may require revision in the future. In the mean time, I hope to describe some of the basics I've discovered and attribute my newly found health.

How does raw dairy differ from processed dairy (pasteurized, homogenized, or ultra-homogenized)? Here are some of the differences.

1. Pharmaceutical and genetic influences: Coming from pasture raised cows, diary is absent of contaminants from low-grade antibiotic therapy given to feed-lot cows. Recombinant bovine growth hormone (rBGH) and its cumulative effects, in addition to genetically modified feed is also absent. The hormone rBGH stimulates insulin-like growth factor-1 (IGF-1), which is associated with breast, colon, and prostate cancer.

2. Nutritional Attributes: Pasteurization destroys vital enzymes. Many people complain of being lactose intolerance. Milk contains a disaccharide (milk sugar) called lactose. There is an inherent inability in some people breakdown lactose as we age. This may be due to our decreased dependence on milk in early development or there may be other explanations such as a genetic predisposition. What ever the cause, with lactose intolerance our intestinal villi do not secrete enough lactase (an enzyme) to breakdown lactose into monosaccharides, glucose and galactose. Once broken down, glucose gets absorbed into the bloodstream and galactose continues to break down further into glucose for transport, again to the blood.

3. Raw milk also contains bacteria-friendly lactobacilli to that breaks down lactose. Pasteurization destroys this bacteria altering milk composition. So, people who are lactose intolerant are in reality pasteurization intolerant. They can often consume raw dairy products without difficulty, especially fermented dairy since the bacteria digests lactose during fermentation.

4. Phosphatase, an essential enzyme utilized in calcium absorption in conjunction with vitamin D (found in raw cream) is destroyed during pasteurization contributing to decreased mineralization processes needed for continued osteogenesis.

5. Catalase, an anti-oxidizing enzyme is also destroyed in pasteurization. Catalase is used to deactivate hydrogen peroxide and toxins including phenols and alcohols. Combine this with the increased bioavailability resulting from the the activating process (from fractured lipid globules) of Xanthine oxidase (XO), a reactive oxygen species (ROS) synergized in the presence of testosterone has been shown to be atherosclerotic especially for men and the soup for heart disease is beginning to be prepared. During homogenization, fractioning lipid globules can trigger a free-radical cascade potentially stimulating allergic responses, inflammation, and atherosclerosis.

6. Perhaps the least known and most profound benefits come from application of its anti-oncogenic properties. Dr. Burzinski, a physician and scientist, currently doing multiple FDA phase II clinical trials extracted four antineoplaston (ANP) ingredients from whey, milk, feta and farmer's cheese that have been shown to deactivate oncogenes and activate tumor suppressor genes. They are 3-phenylactylamino-2, 6-piperidinedione, phenylacetylglutamine, and phenylacetylisoglutamine. If you want to learn about his research of treating cancer a documentary can be found here. This anti-cancer therapy is generally considered more effective and less toxic than both chemotherapy and radiation treatment.