An immunomodulatory polysaccharide from Fruit

The fruit juice of Morinda citrifolia (noni) contains a polysaccharide-rich substance (noni-ppt) with antitumour activity in the Lewis lung (LLC) peritoneal carcinomatosis model. Therapeutic administration of noni-ppt significantly enhanced the duration of survival of inbred syngeneic LLC tumour bearing mice. It did not exert significant cytotoxic effects in an adapted culture of LLC cells, LLC1, but could activate peritoneal exudate cells (PEC) to impart profound toxicity when co-cultured with the tumour cells. This suggested the possibility that noni-ppt may suppress tumour growth through activation of the host immune system. Concomitant treatment with the immunosuppressive agent, 2-chloroadenosine (C1-Ade) or cyclosporin (cys-A) diminished its activity, thereby substantiating an immunomodulatory mechanism. Noni-ppt was also capable of stimulating the release of several mediators from murine effector cells, including tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-10, IL-12 p70, interferon-gamma (IFN-gamma) and nitric oxide (NO), but had no effect on IL-2 and suppressed IL-4 release. Improved survival time and curative effects occurred when noni-ppt was combined with sub-optimal doses of the standard chemotherapeutic agents, adriamycin (Adria), cisplatin (CDDP), 5-fluorouracil (5-FU), and vincristine (VCR), suggesting important clinical applications of noni-ppt as a supplemental agent in cancer treatment.

Veteran Smokers

Despite the detrimental effects of smoking, approximately 33% of veterans continue to smoke compared to approximately 21% of the general population. While efficacious cessation interventions are available, implementation of cessation interventions remains a challenge and new intervention strategies are needed to reach veterans. VA cessation providers recently met in Atlanta and one recommendation was to develop a cessation website for veterans. The evidence-based Tobacco Tactics website will be designed, pre-tested, and pilot tested as an intervention to assist veteran smokers to quit smoking. The efficacy of the website will then be tested in a subsequent randomized control trial (RCT). If the website proves efficacious, it would decrease morbidity and mortality among veterans, decrease face-to-face cessation intervention time for providers, and reach veterans in areas all over the country, perhaps through the VA "My Healthy Vet" website. This is a Phase 1 behavioral clinical trial designed to develop and pilot test a web-based Tobacco Tactics intervention tailored to veteran smokers. First, we will outline the specific content areas to be addressed. Second, we will develop the Tobacco Tactics intervention with our web designer in accordance with VA Web Operations. Third, a member of the research team will go through the website with the 5 veteran smokers obtaining feedback and noting any problems that occur. Fourth, with human studies approval, we will pilot test the impact of the intervention with 9 veteran smokers recruited to quit smoking using the Tobacco Tactics website. A research nurse will:

1. be available by phone to answer any questions;
2. collect qualitative data on veterans use of the Tobacco Tactics website; and,
3. note the 30 day quit rate.

Formative evaluation during pre-testing will include qualitative feedback on the:

1. ability to accomplish tasks;
2. ability to accomplish goals with skill and speed;
3. ability to operate the system; and
4. satisfaction.

For the 9 veteran smokers that actually try to use the Tobacco Tactics website to quit smoking, we will be able to determine:

1. the number of times they signed onto the website;
2. the time spent on the website; and
3. the number of times each module was accessed.

Be Involved in Your Health Care

The Following Tips is useful to us:

1. The single most important way you can help to prevent errors is to be an active member of your health care team.

That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

Medicines

2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.

At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.

3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

This can help you avoid getting a medicine that can harm you.

4. When your doctor writes you a prescription, make sure you can read it.

If you can't read your doctor's handwriting, your pharmacist might not be able to either.

5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.

• What is the medicine for?
• How am I supposed to take it, and for how long?
• What side effects are likely? What do I do if they occur?
• Is this medicine safe to take with other medicines or dietary supplements I am taking?
• What food, drink, or activities should I avoid while taking this medicine?

6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?

A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

7. If you have any questions about the directions on your medicine labels, ask.

Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.

Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.

9. Ask for written information about the side effects your medicine could cause.

If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Hospital Stays

10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.

Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.

Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.

This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

Surgery

13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.

Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

Other Steps You Can Take

14. Speak up if you have questions or concerns.

You have a right to question anyone who is involved with your care.

15. Make sure that someone, such as your personal doctor, is in charge of your care.

This is especially important if you have many health problems or are in a hospital.

16. Make sure that all health professionals involved in your care have important health information about you.

Do not assume that everyone knows everything they need to.

17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't).

Even if you think you don't need help now, you might need it later.

18. Know that "more" is not always better.

It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

19. If you have a test, don't assume that no news is good news.

Ask about the results.

20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.

Aging

The United States is on the brink of a longevity revolution. By 2030, the proportion of the U.S. population aged 65 and older will double to about 71 million older adults, or one in every five Americans. The far-reaching implications of the increasing number of older Americans and their growing diversity will include unprecedented demands on public health, aging services, and the nation’s health care system.

Chronic diseases exact a particularly heavy health and economic burden on older adults due to associated long-term illness, diminished quality of life, and greatly increased health care costs. Although the risk of disease and disability clearly increases with advancing age, poor health is not an inevitable consequence of aging.

Much of the illness, disability, and death associated with chronic disease is avoidable through known prevention measures. Key measures include practicing a healthy lifestyle (e.g., regular physical activity, healthy eating, and avoiding tobacco use) and the use of early detection practices (e.g., screening for breast, cervical, and colorectal cancers, diabetes and its complications, and depression).

Critical knowledge gaps exist for responding to the health needs of older adults. For chronic diseases and conditions such as Alzheimer's disease, arthritis, depression, psychiatric disorders, osteoporosis, Parkinson's disease, and urinary incontinence, much remains to be learned about their distribution in the population, associated risk factors, and effective measures to prevent or delay their onset.

Japanese Encephalitis (JE)

Mode of Transmission

• JEV is transmitted to humans through the bite of an infected mosquito, primarily Culex species. Wading birds are the main animal reservoir for the virus, but the presence of pigs greatly amplifies the transmission of JEV.
• Humans are a dead-end host in the JEV transmission cycle.

Occurrence

• JEV is the most common cause of encephalitis in Asia, occurring throughout most of Asia and parts of the western Pacific (Map 2-5). JEV has not been locally transmitted in Africa, Europe, or the Americas.
• JEV transmission principally occurs in rural agricultural areas, often associated with rice production and flooding irrigation. In some areas of Asia, these ecologic conditions may occur near or occasionally within urban centers.
• In temperate areas of Asia, transmission is seasonal, and human disease usually peaks in summer and fall. In the subtropics and tropics, seasonal transmission varies with monsoon rains and irrigation practices and may be extended or even occur year-round.
• In endemic countries, JE is primarily a disease of children. However, travel-associated JE can occur among persons of any age.

Risk for Travelers

• The risk for JE for most travelers to Asia is extremely low but varies according to season, destination, duration, and activities. Fewer than 40 cases of confirmed JE have been reported in travelers in the last 40 years.
• The overall incidence of JE reported among people from nonendemic countries traveling to Asia is <1>
• Travelers on even brief trips are probably at increased risk if they have extensive outdoor or nighttime exposure in rural areas, including persons staying in resort areas or with family.
• Short-term travelers whose visits are restricted to major urban areas are at very minimal risk for JE.
• In endemic areas where there are few human cases among residents because of vaccination or natural immunity, JEV is often maintained in an enzootic cycle between animals and mosquitoes. Therefore, susceptible visitors still may be at risk for infection.

Clinical Presentation

• Most human infections with JEV are asymptomatic; <1%>
• Acute encephalitis is the most commonly recognized clinical manifestation of JEV infection. Milder forms of disease such as aseptic meningitis or undifferentiated febrile illness can also occur.
• The incubation period is 5–15 days. Illness usually begins with sudden onset of fever, headache, and vomiting. Mental status changes, focal neurologic deficits, generalized weakness, and movement disorders may develop over the next few days.
  • A parkinsonian syndrome resulting from extrapyramidal involvement is a very distinctive clinical presentation of JE.
  • Acute flaccid paralysis, with clinical and pathological features similar to poliomyelitis, has also been associated with JEV infection.
  • Seizures are very common, especially among children.
• Clinical laboratory findings include moderate leukocytosis, mild anemia, hyponatremia, and cerebrospinal fluid (CSF) pleocytosis with a lymphocytic predominance.
• Case–fatality ratio is approximately 20%–30%. Among survivors, 30%–50% may still have significant neurologic or psychiatric sequelae, even years after their acute illness.

Diagnosis

• JE should be suspected in a patient with evidence of a neurologic infection (e.g., encephalitis, meningitis, or acute flaccid paralysis) who has recently traveled or resided in an endemic country in Asia or the western Pacific.
• Laboratory diagnosis of JEV infection should be performed by using JE-specific IgM-capture enzyme-linked immunosorbent assay (ELISA) on CSF or serum. JE-specific IgM antibodies will be present in the CSF or blood of almost all patients by 7 days following onset of symptoms. A fourfold or greater rise in JEV-specific neutralizing antibodies between acute- and convalescent-phase serum specimens may be used to confirm the diagnosis.
• Vaccination history, date of onset of symptoms, and information regarding other flaviviruses known to circulate in the geographic area that may cross-react in serologic assays need to be considered when interpreting results.
• Humans have low levels of transient viremia and usually have neutralizing antibodies by the time distinctive clinical symptoms are recognized. Virus isolation and nucleic-acid amplification tests (NAATs) are insensitive for the detection of JEV or JE viral RNA in blood or CSF and should not be used for ruling out a diagnosis of JE.
• Health-care providers should contact their state or local health department or CDC’s Division of Vector Borne Infectious Diseases at 970-221-6400 for assistance with diagnostic testing.

Treatment

There is no specific antiviral treatment for JE; therapy consists of supportive care and management of complications.

Healthy Eating

Eating healthfully means getting the right balance of nutrients your body needs to perform every day. You can find out more about your nutritional needs by checking out the 2005 Dietary Guidelines for Americans. Published by the U.S. Government, this publication explains how much of each type of food you should eat, along with great information on nutrition and physical activity. The guidelines suggest the number of calories you should eat daily based on your gender, age, and activity level.

According to the guidelines, a healthy eating plan includes:

• fruits and vegetables
• fat-free or low-fat milk and milk products
• lean meats, poultry, fish, beans, eggs, and nuts
• whole grains

In addition, a healthy diet is low in saturated and trans fats, cholesterol, salt, and added sugars.

When it comes to food portions, the Dietary Guidelines use the word "servings" to describe a standard amount of food. Serving sizes are measured as "ounce-" or "cup-equivalents." Listed below are some tips based on the guidelines that can help you develop healthy eating habits for a lifetime.

Tips for making wise choices

* Include milk as a beverage at meals. Choose fat-free or low-fat milk.
* If you usually drink whole milk, switch gradually to fat-free milk, to lower saturated fat and calories. Try reduced fat (2%), then low-fat (1%), and finally fat-free (skim).
* If you drink cappuccinos or lattes—ask for them with fat-free (skim) milk.
* Add fat-free or low-fat milk instead of water to oatmeal and hot cereals
* Use milk products as dipUse fat-free or low-fat milk when making condensed cream soups (such as cream of tomato).
* Have fat-free or low-fat yogurt as a snack.
* Make a dip for fruits or vegetables from yogurt.
* Make fruit-yogurt smoothies in the blender.
* For dessert, make chocolate or butterscotch pudding with fat-free or low-fat milk.
* Top cut-up fruit with flavored yogurt for a quick dessert.
* Top casseroles, soups, stews, or vegetables with shredded low-fat cheese.
* Top a baked potato with fat-free or low-fat yogurt.