Confusing cause and effect in public health policy

When studying the literature on current public health policy challenges, a number of rankings can be found, created from data collected and processed by different methods and from different sources, ordering the challenges by their significance. Inevitably, in global studies, there are errors caused by averaging data across populations that differ significantly in population size and the causes of the decline in disability-adjusted life years (DALYs), potentially in combination with years of life lost (YLL) and years of life lived with disability (YLD), that may serve as indicators of the health status of a given population (Lopez 2005). Averaging data from populations that differ significantly in size, the larger population dominates and the main causes of health problems may be the same in both populations, and malnutrition and infectious diseases should be targeted, although in the smaller population cardiovascular disease is the main risk. A study published in 2018 shows that there are significant differences between countries and regions in the causes of the decline in DALYs and the increase in YLL and YLD (Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017 2018). Some similarities in the order of factors influencing the above indicators can be found in populations with comparable economic performance. In the so-called developed countries, demographic development, in other words, low birth rates resulting in aging of the population, and a significant increase in psychological disorders, are considered to be the core problem (Walker et al. 2015). Caution is needed in assessing the latter issue; bias may arise because mental health is given more attention in developed countries than in areas where even basic needs such as sufficient food and drinking water are not fully met, or where stressors such as military conflict or terrorism are present. On the other hand, lifestyles, associated with an abundance or surplus of resources and, thanks to generous social systems, the risk of dissolving the line between work and reward and the consequent absence of meaningful activity can pose a risk to the development of mental disorders (Dogra et al. 2022; Kim et al. 2013). Even with a cautious approach to global data, time is another factor that increases the opacity of the public health landscape. Over the last 30 years, there has been a significant rearrangement in the ranking of the most important factors influencing DALYs, YLL, and YLD. The top spot occupied in 1990 by lower respiratory tract infections has been taken by coronary heart disease in 2020, diarrheal diseases by unipolar depression and perinatal conditions, perhaps somewhat surprisingly, by traffic accidents (Anish and Sreelakshmi 2013).

PMA - Zeolite (Clinoptilolite) in the Management of Irritable Bowel Syndrome - a Non-Interventional Study

In clinical practice, the treatment of patients with irritable bowel syndrome (IBS) can be very challenging. The aims of the present non-interventional study (NIS) were to investigate the tolerability and efficacy of PMA-zeolite under everyday conditions in patients with diarrheic IBS type (IBS-D) or constipated type (IBS-C) or mixed type (IBS-M).

METHODS

To document prospective data on tolerability and symptom frequency in the frame of a nationwide NIS, we recruited 204 IBS patients. The study focused on the IBS-related quality of life (measured by the SF-36 questionnaire) and improvements of IBS-related symptoms according to specific ROM-III criteria and stool consistency (Bristol stool scale). The participants documented their abdominal pain, bloating, number of bowel movements, and stool consistency through a web-based internet platform (initial and exit questionnaires) and daily diary entries over the period of intake (8 weeks).

RESULTS

A total of 82.2% of the recruited patients had filled in the questionnaires before and after the 8-week treatment with PMA-zeolite. Seven of the eight subscales of the SF-36 improved significantly (p<0,001); the reduction in abdominal pain was especially significant (p<0,001). The diary entries confirmed the reduction in abdominal pain and revealed a significant reduction in days with bloating (p<0,001). The Bristol-stool-scale analysis showed improvements; particularly, patients with IBS-D benefited from the treatment (p<0,001).

CONCLUSION

The treatment duration of 8 weeks was well tolerated by most patients. Under everyday life conditions, PMA-zeolite alleviated the global IBS-related symptoms and raised the quality of life (QOL). The PMA-zeolite, thus, may represent a good adjuvant therapeutic option for patients with irritable bowel syndrome.

Collapse of Healthcare Providers-medical and Paramedical-healthcare Staff after last Three Years of Pandemics and War Conflicts

This Editorial dispatch focuses on absolute shortage of healthcare workers and their psychical and physical exhaustion with devastation consequences on healthcare providers and management of pandemics and health destruction within ongoing armed conflicts in Europe and Middle East,focusing on non prioritizing HCW versus healthcare infrastructure, vaccines medications, but putting both to the same level of priority.

Holding Together for Curing This Wounded World

The current crisis in Ukraine has not only caused endless human suffering, but also implies to the European Countries neighboring at Ukraine borders an important humanitarian task. However, currently in some journals concerns are raised against an immediate aid policy and towards uncontrolled receiving of refugees. These critics refer to the financial challenge of the European Community and raise concerns towards health hazards and public health risks probably linked to this humanitarian crisis.

Building Bridges Between Social Work and Prenatal Psychology

This issue of Clinical Social Work and Health Intervention is dedicated to decea- sed co-founder of our Journal and President of the International Society of Prenatal and Perinatal Psychology and Medicine, Director of the First Department of Peri- natal Psychology and Medicine, Honorary Doctor and holder of Honorary Degrees and Medals of multiple Universities in Poland, Czechoslovakia, Italy, Malaysia, etc, Doctor of Medicine and Psychology and Editor in chief of four Medical Journ- als: Acta Neurosa Superioris Rediviva, Neuroendocrinology Letters, Clinical Social Work and Health Intervention and Int. Journal of Prenatal and Perinatal Psychology and Medicine (1-4). Together with his spouse Lili Maas, ArtD., who added to the exact science, arts and her heart and love, all of those Journals were not only reading of naked facts and theories, or science but both were teaching us to accept psycho- logy, social work and medicine as art culture and love, what is more than science and knowledge, more than facts. (From the letter of St. Paul and two letters of St. Peter, New Testament)

PMA-zeolite can modulate inflammation associated markers in irritable bowel disease - an explorative randomized, double blinded, controlled pilot trial

OBJECTIVES

Preclinical and clinical data suggest, that the microporous mineral with large inner surface and ion exchanger capability PMA-(Panaceo-micro-activation)-zeolite can bind irritating and inflammation associated chime-constituents. We hypothesised whether or not it can ameliorate subclinical inflammation, and investigated the potential in the management of patients with Irritable Bowel syndrome (IBS).

METHODS

The trial design was prospective, randomized, controlled, double-blinded, pilot study with 41 patients. They received orally 3 g of the medicinal product PMA-zeolite or microcrystalline cellulose (control) twice a day. At baseline and after three months the symptom load, blood and stool parameters, like high sensitivity C-reactive protein (hsCRP), zonulin, α1-antitrypsin, interleukin IL-10, and changes in the gut microbiome were determined by means of ANOVA, ANCOVA and non parametric statistical analyses.

RESULTS

The IBS-associated symptom scores decreased significantly in both groups (p=0,001) indicating a strong placebo effect. In the verum but not in the placebo group various inflammation related laboratory parameters decreased. The gross statistical comparison revealed a reduction of α1-antitrypsin significant (p=0,037), a lowered inflammation marker hsCRP, paralleled specific microbiome changes (Lactobacillus, Bifidobacteria, and Firmicutes).

CONCLUSIONS

The decrease of blood hsCRP and decreased stool α1-antitrypsin suggest that PMA-zeolite possibly can lower inflammation in the gut of IBS patients. The corresponding increase of the immune modulating species Bifidobacteria and Lactobacillus and the reduction of Firmicutes also point at an inflammation ameliorating effect and a possible mucous layer strengthening effect. The protocol of this explorative pilot study is feasible for a sufficiently powered trial on inflammation amelioration in IBS patients.

Potential of the multivitamin-mineral-trace element composition LaVita® before, during and after pregnancy

OBJECTIVES

Pregnancy is a period in life with a high demand of micronutrients. A prophylactic supplementation of folic acid to reduce the risk of neurological malformations in the newborn is common practice. The array of essential micronutrients during pregnancy includes neurotropic vitamins (Vitamin B6, B12 and folic acid), minerals like iron, and trace elements like zinc. As the serum level of most micronutritients is actively regulated by the organism, a prophylactic broad supplementation with a mild, but effective supplementation typically does not pose any risk for exaggerated serum levels, therefore prophylactic intake may be prefered to blood screening and specific interventions.

METHODS

To investigate the ingredients' bioavailability of the complex vitamin-mineral-trace element composition LaVita® we recruited healthy volunteers for six months and observed the changes of pregnancy relevant parameters by means of laboratory measures. The study design was prospective, double blind, placebo controlled, and included a "male group control". We determined baseline parameters of folate, vitamin B6 and vitamin B12, iron, zinc, homocysteine and Hb-alpha-1c. After three and six months of daily intake of the study substance the blood tests were repeated and compared to the baseline levels.

RESULTS

The regular intake resulted in an increase of the supplemented substances' serum levels. The metabolic parameter homocysteine decreased significantly, Hb-alpha-1c was slightly lowered.

CONCLUSION

The regular intake filled up the respective storage compartments and reservoirs in the tissues, and improved the metabolic status. Female participants tended to benefit more than male. We conclude that the composition is safe, and warrants optimized micronutrient supply during pregnancy or postnatal breastfeeding.

Prevention of "nitrosative stress" by a nutritional supplement (LaVita®) - a randomized placebo controlled double blind clinical trial with healthy volunteers

BACKGROUND

A common pathomechanism involved in many degenerative manifestations of non-communicable diseases is nitrosative stress, giving rise to a chronic insidious inflammation causing silent inflammation at a cellular level. The release of nitric oxide inhibits multiple enzyme reactions with reduced oxidative phosphorylation and mitochondrial ATP depletion.

MATERIAL AND METHODS

We hypothesized that enzyme-inhibition can be alleviated by micronutrient supply, and studied laboratory parameters associated with nitrosative stress (nitrotyrosine, mitochondrial activity) after a micronutrient supplementation (a multivitamin mineral and trace element formulation as verum: LaVita®) and a placebo in healthy volunteers (n=150) for six months.

RESULTS

Mean nitrotyrosine levels dropped significantly after 3 month in the verum and placebo group, whereas mitochondrial activity increased after three month in the verum group (p=0,087), but not in the placebo group (p=0,990). Ubiquinone - an essential ingredient for mitochondrial function- increased after six months in the verum group, but not after placebo consumption (p=0,001). Serum zinc and cellular zinc increased steadily after 3 and 6 month verum intake (p<0,001). As the enzyme superoxide dismutase (SOD) is mainly involved in the formation of nitrosative stress (peroxides) we measured the activity, and found significant differences in the placebo and verum group after 3 and 6 month (p=0,050 and p=0,003 respectively).

CONCLUSION

We conclude that a balanced combination of vital nutrients may reduce nitrosative stress and silent inflammation, and consequently the risk for various forms of degenerative diseases.

Mood improving Potential of a Vitamin Trace Element Composition--A randomized, double blind, placebo controlled clinical study with healthy volunteers

OBJECTIVES

Neurotransmitters regulate mood, attention vigilance and other clinical symptoms linked with depression. Various medications ameliorate symptoms of depression and mood disorders by interference with the serotonic metabolism. Serotonin metabolism depends on nutritional cofactors such as pyridoxin together with essential mineral and trace elements. Both, inflammation and metabolic conditions seem to affect the bioavailability of serotonin crucially. We hypothesized that serotonin supply depends on relevant gastrointestinal precursor absorption and on the availability of nutritive antiinflammatory cofactors.

METHODS

We performed a randomized placebo controlled clinical trial in healthy participants to study the bioavailabilty of ingredients of the multivitamin and trace element LaVita' in a prospective randomized placebo controlled double blind trial to establish the mood ameliorating potential. Serotonin and its precursor tryptophan were measured in dry blood samples. Serum parameters like chromium and zinc, as well as vitamin D, vitamin B3 and B6 were determined before intake, and after 3 months and 6 months consumption of the test substances.

RESULTS

After 3 months a slight increase of tryptophan (p=0.059) and a significant increase of serum serotonin (p < 0.013) was observed in the verum group. After 6 months the verum group showed a highly significant mean increase in niacin (p < 0.001) and the cofactors of serotonin metabolism pyridoxin (p=0.03), chromium p < 0.01), and zinc (p < 0.001). Serotonin levels droped after 6 months indicating a low risk for overdosing.

CONCLUSION

We conclude that a continuous supply with ingredients from the natural source compound LaVita' may contribute to mood improving neurotransmitter activity.

Bioavailabilty of a liquid Vitamin Trace Element Composition in healthy volunteers

BACKGROUND

Many Vitamins and minerals for dietary supplements lack a standard scientific and regulatory definition that accurately reflects the bioavailabilities in humans. Especially the bioavailability of natural compounds in complex mixtures, where the different ingredients may interfere with each other, is unknown.

METHODS

To learn more about the bioavailability of the ingredients in the complex compound LaVita® we examined blood levels of subjects, who ingested the multivitamin and trace element composition for 6 month continuously. Blood samples for the analysis of the ingredients were taken before, during, and after administration.

RESULTS

Our data indicated a significant increase of most ingredients after 3 month, and additional three months, except for Vitamin (B9 Folic acid). The semivitamins Q10 and carnitine increased in the first 3 month (both p<0.001). While carnitine dropped during the second term, Q10 levels increased further slowly. After three months a significant increase was observed for iron (serum p=0.039; blood cells p=0.025), Selenium (serum p=0.048; cells p=0.006), and chromium (serum p=0.029). Zinc - known to interfere with the iron resorption - increased slowly in the first term of 3 months, but was raised significantly after 6 months (serum and blood cells, each p<0.001). The Copper/Zink ratio dropped accordingly (p<0.001).

CONCLUSION

We conclude that resorption interference between specific ingredients, and after resorption redistribution of specific ingredients to various tissue compartments precludes a linear increase of the respective serum parameters. We observed no deleterious resorption competitions for individual compounds. No parameter reached critical levels. We conclude that the test substance (LaVita®) is a sufficiently safe composite for long term consumption.

Neuroprotective impact of a vitamin trace element composition - a randomized, double blind, placebo controlled clinical trial with healthy volunteers

OBJECTIVES

Neurotoxic metabolites and oxidative and nitrosative stress reactions play a crucial role in the pathways leading to neuronal cell death and neurodegeneration. The bioavailability of the many antioxidant ingredients a vitamin and trace element composition was investigated, to reveal the neuroprotective (preventive) potential of the composition.

METHODS

We recruited 159 healthy volunteers, assigned them randomly and double blind to a placebo and verum group. Physicians excluded volunteers with severe chronic diseases or interfeering medications. 142 participants finished the six month trial. Laboratory parameters were determined 1) before participation, and 2) after three and 3) six months. We confirmed the bioavailability of ingredients, and determined metabolic parameters associated with the integrity of the blood brain barrier, mitochondrial deficiency (Q 10), neurodegeneration (homocystein), and antioxidative capacity (e.g. lipidperoxidation), and superoxiddismutase activity.

RESULTS

Starting from baseleine, after three months neuroprotective ingredients increased within their physiological borders, folic acid (p<0.003), pyridoxin (p<0.001), cobalamin (p=0.001), and the fat soluble vitamin tocopherol (p<0.001). In parallel, homocytein decreased after 3 and 6 months (p<0.001, and p<0.025, respectively). Other paramters like zinc reacted slower, significant changes were observed only after 6 months.

CONCLUSION

The observed metabolic changes and alteration of the oxidative status after 3 and six month of regular intake underlines the compositions' potential to ameliorate neurodegenerative processes. We conclude that the subsitution of vitamins and trace-elements with natural source in a proper manner may be effective for neuroprotection in healthy population.

Epirubicin and docetaxel with or without capecitabine as neoadjuvant treatment for early breast cancer: final results of a randomized phase III study (ABCSG-24)

BACKGROUND

This randomized phase III trial compared pathologic complete response (pCR) rates of early breast cancer (EBC) following neoadjuvant epirubicin-docetaxel (ED)±capecitabine (C), and evaluated the addition of trastuzumab in HER2-positive tumors.

PATIENTS AND METHODS

Patients with invasive breast cancer (except T4d) were randomly assigned to receive six 3-weekly cycles of ED (both 75 mg/m2)±C (1000 mg/m2, twice daily, days 1-14). Patients with HER2-positive disease were further randomized to receive trastuzumab (8 mg/kg, then 6 mg/kg every 3 weeks) or not. Primary end point: pCR rate at the time of surgery.

RESULTS

Five hundred thirty-six patients were randomized to ED (n=266) or EDC (n=270); 93 patients were further randomized to trastuzumab (n=44) or not (n=49). pCR rate was significantly increased with EDC (23.0% versus 15.4% ED, P=0.027), and nonsignificantly further increased with trastuzumab (38.6% EDC versus 26.5% ED, P=0.212). Rates of axillary node involvement at surgery and breast conservation were improved with EDC versus ED, but not significantly; the addition of trastuzumab had no further impact. Hormone receptor status, tumor size, grade, and C (all P≤0.035) were independent prognostic factors for pCR. Trastuzumab added to ED±C significantly increased the number of serious adverse events (35 versus 18; P=0.020), mainly due to infusion-related reactions.

CONCLUSION

These findings show that the integration of C into a neoadjuvant taxane-/anthracycline-based regimen is a feasible, safe, and effective treatment option, with incorporation of trastuzumab in HER2-positive disease.

CLINICAL TRIAL NUMBER

NCT00309556, www.clinicaltrials.gov.

Papaya preparation (Caricol®) in digestive disorders

OBJECTIVE

Papaya (Carica papaya L.) is used as a natural remedy in abnormal digestion in tropical and industrialized countries. Besides this wide distribution little evidence has been produced with reference to its physiological effect in humans and the proof of efficacy. Former clinical observations had revealed positive effects for patients with constipation, heartburn, and symptoms of irritable bowel syndrome (IBS) after eating papaya preparations. In line with these former positive clinical observations, we studied the clinical effects of the papaya preparation Caricol® in a double blind placebo controlled study design.

METHODS

In this study the participants were volunteers, with chronic (prevailing) indigestions and dysfunctions in the gastrointestinal tract. During the trial the intake of the substance of intent and placebo was 20 ml daily for 40 days. The endpoints were the frequency of 22 symptoms recorded before and after the documented intake recorded by questionnaire.

RESULTS

The symptoms "Constipation", "Bloating", and "Heartburn" were defined as primary and frequency of "painful (straining) bowel movements" as secondary endpoint. The participation ended after the intake period within two days ("early returnees"). Wash out effects were observed in "late returnees", who returned with a delay of 8.6 (±5.95 days). In the verum group early returnees revealed statistically significant improvements of the symptoms "constipation" and "bloating". The analysis of "heartburn" felt short of significant improvement because of the small number of included cases with this criteria (N=13, p=0.114). None of the significant benefits were observed after the washout phase.

CONCLUSION

We conclude from these results, that the papaya preparation (Caricol®) contributes to the maintenance of digestive tract physiology. It ameliorates various functional disturbances, like symptoms of IBS. The mechanism of this digestive tract physiology support is discussed.

The effectiveness of choline citrate infusions monitored by lymphocyte transformation test (LTT) in multiple sclerosis. A new approach to the diagnosis and treatment of the disease

The efficacy of intravenous choline citrate infusions was investigated in 34 patients with multiple sclerosis (MS) by clinical evaluation and by monitoring of lymphocyte proliferation in vitro against fragments of myelin basic protein (MOG-35-55, MBP15-31, PLP 39-15) over a period of 12 weeks. Patients have been diagnosed with MS at least one year before entering the study and suffered from mild relapsing/remitting course to long-term chronic progressive disease. Twenty one patients exhibited positive lymphocyte proliferation to myelin fragments prior to treatment and were therefore selected for further studies. Choline citrate was administered with a dosage of 1200mg/ 2x week for a period of 3 months. This treatment resulted in a significant decrease of lymphocyte proliferation to neural fragments (MOG- 35-55, MBP15-31) in lymphocyte transformation test (LTT). There was no significant SI change of PLP Peptide (PLP 39-15) LTT found after treatment with choline citrate. During the 3 mo observation period, patients remained stable and no side-effects of the treatment were observed. In addition, some patients reported long-lasting improvement (less paresthesia and increase of muscle strength in lower extremities) which was demonstrated up to 3 years later. In one spectacular case a commercial pilot was able to return to duty again after treatment. This pilot was allowed back in to his position as a commercial flying cockpit member and is on duty for more than 4 yrs now.

Gold and palladium burden from dental restoration materials

From 81 volunteers (16 without dental restorations, 65 with gold crowns or inlays) samples of saliva before and after chewing gum, blood, serum, urine and faeces were taken and analysed for gold (Au) and palladium (Pd). The Au concentration in all analysed biomonitors correlates significantly to the number of teeth with gold restorations. For Pd the correlations were still significant, but weaker than for Au. Persons with gold restorations show maximal Au and Pd concentrations, 10(2)-10(3) higher than the background burden. The calculated maximal daily Au load in saliva (1.38 mg Au per day) reaches the range of an oral Au therapy for rheumatoid arthritis with 6 mg Auranofin (= 1.74 mg Au per day). During this therapy severe and frequent side effects are reported. In contrast, the Au concentration in serum maximally reached from Au restorations, amounts to only approximately 1/20 of the Au level during arthritis therapy. But even under subtherapeutic doses of 1 mg Auranofin/day severe side effects have been reported (4 out of 56 cases). The mean Au blood concentration from 1 mg Auranofin daily was only 3 times higher than our maximum value. A toxicological classification of the Pd values is difficult, because no toxicological threshold limit has been established, especially for the low-level long-term burden with Pd.

[Epidemiologic studies of worm burden in the Swabia piglet production and fattening industry]

By means of collected samples the status of parasites in 121 farms of piglet producing management in Swabia was coproscopically investigated in almost 5250 animals of various groups, taking into consideration the different methods of control. In contrast to the animals in 2 of 14 fattening farms (=14.3%) the pigs in 78 of 121 farms, including pure breeding and fattening production (=64.5%) were considerably affected with worms. The highest proportion was with 41 and 56.3% the nudular worms, ascarids occurred, depending on the type of management in anything between 16.2 and 375%, coccidia infestations were determined in 18.8 and 19% and whipeworms i.e. stomach worms could be found in 8.5 i.e. 1% relative values between 1.9 and 12.5% were established in threadworms. With prolonging the intervals of therapy according to the different animal groups as well as a more frequent stay on pasture, a high risk of infection seems to be certain, while the difference of single of mass treatment proved to be insignificant.