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.