Bastyr University
  • Kenmore, WA, United States
Recent publications
There are vital links among mental health conditions, chronic diseases, and substance use disorders. Simultaneous examination of the relationship among these three conditions is essential for providing well-integrated care to rural residents who have limited resources and for representing medically underserved areas. We aimed to assess the burden of behavioral health conditions and chronic diseases from a rural Texas community to garner context-specific insights and inform effective health promotion strategies in similar communities. We conducted a cross-sectional study among 181 residents from various zip codes in a rural Texas county. A self-administered, 18-item health-needs questionnaire was used to collect data from the participants. Of the total participants, 30.0% reported mental health conditions, 16.0% reported substance use disorders, and 44.2% reported having at least one type of chronic disease. Overall, mental health conditions were associated with substance use disorders [OR: 1.58 (95% CI: 0.73–2.42)] and chronic disease [OR: 1.07 (95% CI: 0.39–1.75)], but no associations were observed between substance use and chronic disease [OR: 0.62 (95% CI: -0.20–1.43)]. The economic and accessibility barriers that rural residents commonly face call attention to the need for integrated care that combines primary care and behavioral health services.
Introduction Panax notoginseng (Burkill) F.H. commonly referred to as Sanqi, is a Chinese herb that has long been used to treat various conditions including blood disorders and cardiovascular diseases. While Panax notoginseng has been used as an anti-cancer medicinal herb in recent years, how it achieves this therapeutic effect has not been thoroughly elucidated. The purpose of this study was to reveal more about the mechanism of the cytotoxic effect of Panax notoginseng on prostate cancer (PCa) cells. Methods Ethanol extract of Panax notoginseng root was authenticated using high-performance liquid chromatography (HPLC). The cytotoxic activity of this herb against PCa cells was determined using the 3-(4,5-dimethylthiazol-2-yl)−2,5-diphenyltetrazolium bromide (MTT) method, flow cytometry, and enzyme-linked immunosorbent assay (ELISA). Results The assessment of cellular metabolic activity demonstrated that Panax notoginseng reduces the viability of LNCaP and 22Rv1 cells in a dose-dependent manner. Annexin-V binding flow cytometry assay showed that Panax notoginseng induces apoptosis in PCa cells. Cell cycle analysis by quantification of DNA content using flow cytometry showed that Panax notoginseng arrests the cell cycle at the G2/M phase in both LNCaP and 22Rv1 cells. Moreover, ELISA demonstrated that Panax notoginseng-treated PCa cells secrete significantly less tumor-promoting cytokine interleukin-4 (IL-4) to the supernatant compared with controls. Conclusions These results provide evidence for the cytotoxic effects of Panax notoginseng on PCa cell lines. This botanical is a promising candidate for the complementary and integrative medicine treatment of PCa and further studies are indicated to determine the anti-cancer mechanism of Panax notoginseng.
Objective: Although researchers and policy makers have often considered the U.S.-Mexico border region to be at high risk for substance use problems, epidemiological studies of this region have been hard to interpret because of their modest geographic coverage, reliance on self-report, and mixed results. The current study addresses limitations of existing studies and extends the knowledge base by comparing alcohol- and drug-related mortality in counties on versus off the border across all four U.S. border states. Method: Data were from the 2008-2017 Centers for Disease Control and Prevention WONDER Multiple Causes of Death data set, American Community Survey, and Rural Urban Continuum Codes, including all four border states. Spatial lag models tested differences across on- and off-border counties in total alcohol- and drug-related mortality ("total mortality"), alcohol-related mortality, and drug-related mortality. Results: In multivariate models, mortality rates were significantly higher in off- versus on-border counties for all three outcomes (ps < .05). Rates for total mortality, alcohol-related mortality, and drug-related mortality were 28%, 82%, and 30% higher, respectively, off versus on the border. Border effects were similar, excluding California; robust over time; and stronger for Latinx versus White decedents. Conclusions: Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.
Purpose Breast cancer survivors (BrCS) experience many psychosocial difficulties following treatment, leading to an increased risk of psychological distress compared to the general population. This is especially true for underserved BrCS whose unmet supportive care needs can result in worse physical and mental health outcomes. This qualitative study compared healthcare and support providers’ perceptions of BrCS’ needs to survivors’ perceptions of their own needs. Methods Semi-structured in-depth interviews were conducted with 25 underserved BrCS and 20 cancer survivorship stakeholders identified using purposeful sampling. Using the constant comparison method and content analysis, data were analyzed via an iterative process of coding and discussion. Data were summarized according to three intermediate and proximal themes mentioned by both stakeholders and survivors: (1) psychosocial needs of cancer survivors, (2) support, and (3) benefit finding/positive feelings about cancer. Demographic data were analyzed by calculating descriptive statistics. Results There was consistency in providers’ and survivors’ perceptions of post-treatment mood changes, financial burden, familial stress, and physical changes. Providers and survivors differed in perceptions of BrCS’ preferred sources of care and support, effects of cancer treatment on body image, the effects of fear of cancer recurrence on follow-up care, and benefit finding. Conclusions This study provides valuable insight into areas in which healthcare and support providers’ perceptions may differ from underserved BrCS’ lived experiences. Results from this study can be used to develop interventions and inform healthcare and support providers on how to provide high-quality care to underserved BrCS.
Purpose To compare disease free survival experienced by women who received usual oncologic care compared to a cohort of women who received naturopathic oncology care in addition to usual care. Methods Women with breast cancer who received naturopathic oncology (NO) care in Western Washington State (WA) (N = 176) were recruited to a prospective study of clinical health-related quality of life outcomes and then matched to women who received usual care (UC) only (N = 334). Results Among 510 women with breast cancer stages 1 to 3, a total of 50 women (10%) experienced a disease-free survival (DFS) ending event within the observation period; 23 (6.8% of those in the UC cohort, and 27 (15.3% of those in the NO cohort ( P < .05). Although, women in the 2 cohorts received similar surgical, chemotherapy, and radiation treatment, women with breast cancer who received naturopathic oncology adjunctive care were less likely to use anti-estrogen therapy, and experienced poorer DFS (logrank test, P < .05). However, differences in DFS could not be shown to be due to cohort differences in anti-estrogen therapy, baseline HRQOL, or naturopathic oncology therapies prescribed. The stage 3 women in the naturopathic oncology group had more advanced disease at diagnosis. They were more likely to have 5 or more metastatic lymph nodes at baseline (18.5%) compared to their usual care matched control group (13%). Women in the naturopathic oncology group also had higher grade tumors at diagnosis. Conclusions Results show that recurrence of breast cancer was associated with more advanced malignant lymph node involvement; and that naturopathic oncology services provided in 2009-2015 did not improve disease-free survival in these high-risk breast cancer patients.
Background This rapid review systematically evaluated the effects of honeybee products compared to controls for the prevention, duration, severity, and recovery of acute viral respiratory tract infections (RTIs), including SARS-CoV-2, in adults and children. Methods Cochrane rapid review methods were applied. Four English databases plus preprint servers and trial registries were searched for randomized controlled trials (RCTs). The evidence was appraised and synthesized using RoB 2.0 and GRADE. Results 27 results were derived from 9 RCTs that included 674 adults and 781 children. In hospitalized adults with SARS-CoV-2, propolis plus usual-care compared to usual-care alone reduced the risk of shock, respiratory failure and kidney injury and duration of hospital admission. Honey was less effective than Guaifenesin for reducing cough severity at 60-minutes in adults with non-specific acute viral RTIs. Compared to coffee, honey plus coffee, and honey alone reduced the severity of post-infectious cough in adults. Honey reduced the duration of cough in children compared to placebo and salbutamol; and the global impact of nocturnal cough after one night compared to usual-care alone and pharmaceutical cough medicines. Conclusion: More studies are needed to robustly assess honeybee's role in SARS-CoV-2 and non-specific viral respiratory infections. Protocol registration PROSPERO: CRD42020193847.
Introduction: Effective, scalable interventions to address depression and loneliness and improve the quality of social relationships are needed for public health in pandemic and non-pandemic contexts. Towards this end, a randomized, controlled trial tested a mobile-based intervention, derived from social psychological and relationship science, for improving relational well-being and decreasing depression and loneliness. Methods: Participants were randomly assigned to either intervention (n = 719) or assessment only (n = 701) conditions and completed daily diary surveys for 28 days in the midst of the first wave of the Covid-19 pandemic. In the middle 14 days of the study, intervention participants received daily text-message suggestions for improving relational and mental well-being. Results: Results indicated that the intervention decreased depression and loneliness and improved relationships during the intervention period but these changes were not sustained when the intervention ceased. Discussion: Results are encouraging in that evidence-based suggestions can be scaled effectively but additional efforts are required to sustain improvements over time.
Evangelical Protestant Christianity is the most prevalent religion in America, with women being the dominant practitioners. The Evangelical Purity Movement that gained prominence in the 1990s sought to provide moral and religious based sexual education through private and public policies to both Christian and non-religious youth. This movement directly stressed the concept of abstinence-only until marriage education, while covertly spreading sexual scripts promoting sexual double standards, the mind-body split, female objectification, and sexual shame. The needs and concerns of women raised in this subculture are identified and explored for clinicians unfamiliar with their context. Although the intent of this movement claims to provide moral structure, research related to the main objectives reveal that they also created a negative effect on females that result in physical, emotional, and sexual dysfunction and dissatisfaction. This article provides context and articulates these concerns while calling for a significant increase in research to provide more resources for counselors and clients alike.
Objective: Evidence of effectiveness and demand for acupuncture to treat acute pain conditions is growing, as is the need for acupuncturists trained to deliver patient care in a hospital setting. This articles describes collaboration between Bastyr University and Harborview Medical Center to incorporate Doctor of Acupuncture and Oriental Medicine (DAOM) students into a trauma hospital setting. Materials and methods: A model was developed to integrate DAOM students into an Anesthesiology Acute Pain Service to provide acupuncture to postoperative inpatients. That in-person model pivoted to remote student education and patient self-care education during the COVID 19 outbreak. A review was conducted of 323 consecutive patients who received acupuncture while they were hospitalized. Results: The review of 323 consecutive patients who received acupuncture for pain during their hospital admission indicated that as few as one acupuncture treatment resulted in clinically significant benefits. No serious complications or safety concerns were reported. Conclusions: Collaboration between academic and clinical programs can provide the structure to integrate acupuncture into hospital settings safely and with benefit to patients and students.
We report the effects of mixed omega-7 fatty acid supplementation on changes in serum hsCRP, TNFα, and IL-6 levels and self-reported outcomes in people with non-specific chronic musculoskeletal discomfort. Design: A double-blind, placebo-controlled, 1:1 randomized single crossover trial composed of 688 mg/day palmiteolate for the verum and an equivalent amount of medium-chain triglycerides for the placebo. Method: Data were analyzed in two independent groups and as a crossover group. Results: From 211 screened participants in 2017-2019, 56 were randomized. Six participants dropped out and fifty completers contributed to the statistical analyses. At baseline, none of the investigated biomarkers were significantly correlated to subjectively assessed musculoskeletal discomfort levels. For the two-group analysis (n = 26 and n = 24), none of the serum biomarkers reached statistical significance; however, a statistically significant placebo effect was found in the subjective outcomes. Conclusion: For the crossover analysis (n = 50), three weeks of supplementation with n7FA containing 688 mg per day of palmiteolate did not reduce serum inflammatory biomarkers nor did it improve subjectively measured quality of life (QoL) compared to placebo. Future studies should explore appropriate biomarkers, sufficient power, length of dosing, inclusion criteria for volunteers with higher BMI, and the verification of cis-palmiteolate versus trans-palmiteolate.
Limited access to medications and devices relevant to the care of low‐risk childbearing families acts as a barrier to the successful integration of high‐quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community‐based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state‐licensed midwives. These professionals are the primary health care providers offering community‐based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community‐based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence‐based care. Policy makers can improve health, health equity, consumer choice, and access to evidence‐based care by using ideal legal language for midwifery practice authority.
The disparity in access to agricultural land can be a source of social inequality, impeding community development in rural areas in many developing countries. Previous studies have identified factors that affect landholding size but have failed to understand operational farm size in the area with the coexistence of local indigenous people and internal immigrants. In this study, we conducted 121 interviews with farmers from the buffer zones of Vietnam’s Bu Gia Map National Park to understand the determinants of operational farm sizes of farmers. The findings of this study demonstrate that indigeneity, female-male labor force ratio, education level of heads of households, training in agriculture, and residential communes are statistically significant in explaining the operational farm size of farmers. The findings of this study can support the government and practitioners in assisting community development by creating interventions to reduce social inequality based on socioeconomic profiles.
Objectives Orthorexia is characterized by a fixation on healthful eating that emphasizes specific qualities of foods. The study objective was to investigate knowledge and self-awareness of orthorexia in the general public and nutrition students before and after viewing an online educational module. Methods De-identified online surveys created in REDCap were shared with the general public via social media groups (Facebook and Reddit) and survey exchange sites; and with nutrition students through a convenience sample obtained through nutrition departments of two universities. An educational module with an orthorexia infographic and video included pre- and post-questionnaires to assess change in knowledge of orthorexia. A validated orthorexia questionnaire (ORTO-15) was used to evaluate orthorexia behavior in these populations. Results Study participants who responded to the survey included 253 individuals from the general public and 77 nutrition students. Of the 253 general public respondents, 72 were from survey exchange groups on social media, 20 were from survey exchange websites and 150 were from motivational fitness groups on social media. fter reviewing the educational module, the general public's orthorexia knowledge scores increased from a mean of 3.4 (±1.0) to 4.9 (±1.3) out of a possible score of 7; whereas the nutrition students' orthorexia knowledge scores only increased from 5.2 (±1.3) to 5.7 (±0.9) pre- to post-educational module. This interaction was significant (P < 0.0001). 97.7% of the general public and 93.2% of nutrition students showed an ORTO-15 score of 40 or lower from a possible total score of 60. The majority of the nutrition students (40.3%, n = 29) chose “often” whereas about 50% (n = 109) of the general public chose “sometimes” and 33% (n = 73) chose “often”, when asked about feeling guilty when transgressing on the ORTO-15 questionnaires. Conclusions Both populations showed an increase in knowledge about orthorexia after viewing the educational module. The evidence from this study indicates knowledge of orthorexia is low in these populations and education about the condition may be warranted for the general public and students who are in nutrition-related fields. In both populations, ORTO-15 scores showed existence of some degree of orthorexia-related behavior. Funding Sources No funding was used for this research.
Objectives Currently the only treatment for celiac disease (CD), an autoimmune disease triggered by ingestion of the protein gluten, is a gluten-free (GF) diet. This study aimed to examine some barriers (GF food accessibility, social support, GF food knowledge) to maintaining a GF diet. Methods A deidentified online survey with REDCap was shared with people with celiac disease via social media (celiac disease group and research survey exchange group via Reddit, research survey exchange groups via Facebook, celiac disease Discord server). The survey included questions about diagnosis, symptoms, social support, eating habits, GF food access, disease impact, gluten-free knowledge, and demographics. Analysis included descriptive statistics and qualitative measures were used to determine themes. Results Of the 123 responses, 54.5% were diagnosed with CD by small intestine biopsy, 85.1% maintained a GF diet, and 35.2% had CD symptoms for 1–4 years before receiving a diagnosis. Concerning accessibility, 47.9% reported having some difficulty affording GF foods and 49.2% that local grocery stores had limited selection of GF foods. An analysis of GF bread cost in one Washington State county showed a mean cost per loaf of $6.52 which was $4.98 higher than the average cost of all bread in the U.S. When it came to checking food labels for gluten, 59% reported feeling very confident and most participants were able to correctly identify foods that may contain gluten; however, less than half (47.5%) identified kamut (a type of wheat) as a gluten containing grain. 46.7% reported feeling that having CD impacts their life daily. The majority (64.2%) of participants stated that family and friends are supportive of needs, and 62.3% also shared that they did not live in a home that was free of gluten. Conclusions The results from this study suggest that there may be several types of barriers to maintaining a GF diet in people with CD. This study aims to bring better awareness of the prevalence of food accessibility, social support, and GF food knowledge barriers to those living with CD, and to the nutrition professionals who provide their healthcare. Funding Sources Bastyr University Faculty Student Research Grant
Background Vertically integrating anatomy into pathology curricula is beneficial for student-centered learning. This study investigates the effectiveness of this approach on student learning outcomes.ActivityLearners received a vertically integrated pathology curriculum; their pre- and post-course test data were collected.Results and DiscussionTwo-hundred thirty-two learners participated in the activity. Upon completing the activity, their average post-course performance was significantly better than that of a control group (P < 0.05), with significantly higher scores on solving pathology case problems (P < 0.05), as well as on retaining anatomy concepts (P < 0.05). Vertically integrating anatomy in pathology instruction is an effective educational approach.
Objective Many women with breast cancer refuse adjuvant treatments. How they arrive at their respective decisions and whether they are passively or actively involved in making decisions is less known. We explored the different decision-making behaviors of women who received treatments (receivers) after being diagnosed with breast cancer and those who refused (decliners). Methods Seven women (four receivers and three decliners) were recruited from the Breast Cancer Integrative Oncology Study. We conducted an inductive content analysis based on in-depth semi-structured interviews with open-ended questions. Results Receivers reported that doctors and family members influenced their decision-making. Decliners perceived their doctors as supportive of their decisions and reported that the experience of adjuvant therapy of family and friends, the results of Oncotest, and concerns about side effects influenced their decision-making. Receivers expressed discomfort about their decisions, relied on books, whereas decliners used various sources to find information. Both receivers and decliners believed that they had made the decisions themselves. However, receivers were somewhat negative about doctors' advice. Receivers also reported that, sometimes, the decision-making process was lacking and reported discomfort with the treatment process. Conclusions Women with breast cancer need support in understanding the care they are prescribed and getting essential care.
Intestinal release of incretin hormones after food intake promotes glucose-dependent insulin secretion and regulates glucose homeostasis. The impaired incretin effects observed in the pathophysiologic abnormality of type 2 diabetes have triggered the pharmacological development of incretin-based therapy through the activation of glucagon-like peptide-1 (GLP-1) receptor, including GLP-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase 4 (DPP4) inhibitors. In the light of the mechanisms involved in the stimulation of GLP-1 secretion, it is a fundamental question to explore whether glucose and lipid homeostasis can be manipulated by the digestive system in response to nutrient ingestion and taste perception along the gastrointestinal tract. While glucose is a potent stimulant of GLP-1 secretion, emerging evidence highlights the importance of bitter tastants in the enteroendocrine secretion of gut hormones through activation of bitter taste receptors. This review summarizes bitter chemosensation in the intestines for GLP-1 secretion and metabolic regulation based on recent advances in biological research of bitter taste receptors and preclinical and clinical investigation of bitter medicinal plants, including bitter melon, hops strobile, and berberine-containing herbs (e.g. coptis rhizome and barberry root). Multiple mechanisms of action of relevant bitter phytochemicals are discussed with the consideration of pharmacokinetic studies. Current evidence suggests that specific agonists targeting bitter taste receptors, such as human TAS2R1 and TAS2R38, may provide both metabolic benefits and anti-inflammatory effects with the modulation of the enteroendocrine hormone secretion and bile acid turnover in metabolic syndrome individuals or diabetic patients with dyslipidemia-related comorbidities.
Objectives: To characterize the sexual and reproductive health (SRH) services available to men from publicly-funded family planning clinics in California. Study design: We conducted a cross-sectional telephone survey in 2018 to compare the accessibility of SRH services for male clients at Planned Parenthood clinics in California to those visiting a random sample of 200 other publicly-funded family planning clinics, selected from a California Department of Health Care Services list of 773 that had served at least 15 male clients in the prior year. A representative at each clinic answered questions about provision of 20 clinical services. We examined differences in individual service provision by clinic affiliation using Chi-squared tests. Results: Only one-third (773/2348) of publicly-funded clinics in California served more than 15 male clients each year, with rural clinics less likely than urban counties to do so. We were able to contact 62 of 107 Planned parenthood clinics and 81 of the 200 other publicly-funded family planning clinics that we attempted to reach. Most (95%) offered HIV and STI screening; 65% offered vasectomy consultation, but only 5% provided vasectomy services. Planned Parenthood clinics were more likely than other publicly funded clinics to provide condom demonstrations, emergency contraception, STI testing, HPV vaccination, penile/testicular exams, and infertility testing (p<0.05 for all comparisons). Conclusions: Male family planning services are less frequently offered by rural clinics and by publicly-funded clinics in California that are not affiliated with Planned Parenthood. Implications: Men's underutilization of family planning may be partially explained by a lack of access to clinical services.
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634 members
Paul S Amieux
  • Office of Research Administration
Laurie Mischley
  • Research Institute
Penny Simkin
  • Simkin Center for Allied Birth Vocations
Kara Bensley
  • Department of Public Health
Eric Yarnell
  • Botanical medicine
Kenmore, WA, United States