OREGON STATE UNIVERSITY

college of public health and human sciences

Study: Oregon high schools lacking ‘best practices’ for athletic emergencies

CORVALLIS, Ore. – A survey of Oregon high school athletic directors on their school’s preparedness for a catastrophic injury or health event found that only 11 percent of those responding had implemented three primary “best-practice” recommendations for treating their student-athletes.

Multiple national sports safety organizations have defined institutional best practices, including having a plan in place for when emergencies occur and ensuring the training and accessibility to the proper equipment for those who respond. 

Results of the research have been published in Sports Health, a collaborative publication of the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the National Athletic Trainers’ Association and the Sports Physical Therapy Section.

“We launched the survey to gauge how prepared schools are to respond to athletic-related emergencies,” said Samuel Johnson, an athletic training and kinesiology specialist at Oregon State University and lead author on the study. “We also wanted to know if having an athletic trainer – a health care professional with expertise in sports medicine – available at the school was associated with better preparedness.” 

The researchers asked whether schools had venue-specific emergency action plans, had access to an automated external defibrillator (AED) for early defibrillation in the event of an emergency, and whether they required first responders – specifically coaches – to be trained in cardiopulmonary resuscitation and proper use of an AED.

The OSU-led study found that 29 percent of schools responding to the survey had implemented two of the three best-practice recommendations; 32 percent had implemented one recommendation; and 27 percent had not implemented any of them. The survey received 108 responses, or about 37 percent of all Oregon high schools. 

“There is definitely room for improvement in planning for medical emergencies,” he said. “We are doing some things well in the state, and there are things we need to do better. For example, having an AED available on campus is a great first step, but we need to make sure it is readily available at athletic events and that people are trained to use it.”

Only half of the schools in the study had an athletic trainer available, yet Johnson said having one was associated with better preparedness. 

“Athletic trainers are specifically trained to prevent and respond to emergencies,” Johnson noted. “We found that having an athletic trainer on staff was associated with better preparedness, particularly as it relates to emergency plans and having AEDs on hand. However, having a trainer was not associated with whether schools required coaches to have training in CPR or with a defibrillator.”

Johnson pointed out that while athletic trainers likely are not in a position to mandate that coaches having training, they can take charge in making sure plans are in place and potentially life-saving equipment is available when needed. 

“We understand several of the challenges associated with implementing some of the recommendations,” Johnson said. “Buying AEDs, paying for coach training, or hiring an athletic trainer can be expensive. Budgets are tight and catastrophic medical situations are rare. But they do happen, and they have a devastating impact on the athlete, family and friends.”

The researchers are planning to explore the challenges schools face in implementing best practices. The Oregon School Activities’ Association, which governs high school sports in the state, has been proactive in promoting sports safety, Johnson said. 

“I am always impressed by how well the different groups in the state come together to make sports safer,” said Johnson, who along with several of the study’s co-authors are members of the OSAA’s Sports Medicine Advisory Committee. “The OSAA has been a driving force in getting coaches, athletic directors, athletic trainers, physicians and other stakeholders talking about these issues and making changes to improve safety.

“For example, starting this year there is a requirement that schools have an emergency action plan for athletics. These collaborative efforts don’t happen in every state, though they probably should.” 

Johnson, who is in the College of Public Health and Human Sciences at OSU, is taking the message outside of Oregon. He will address a worldwide audience of sports medicine professionals on preparedness at the International Olympic Committee’s World Conference on Prevention of Injury and Illness in Sport later this year.

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Sam Johnson, 541-737-6801, sam.johnson@oregonstate.edu

Workers’ compensation claims offer insight into seafood processing injuries in Oregon

CORVALLIS, Ore. – A review of workers’ compensation claims indicates that workers in Oregon’s seafood processing industry are suffering serious injuries at higher rates than the statewide average, and the rate of injuries appears to be on the rise, researchers at Oregon State University have found.

Researchers examined 188 “disabling” claims, or claims from employees who missed work, were hospitalized overnight or whose injuries left them permanently impaired. They found that the average annual rate of claims was 24 per 1,000 workers, said Laura Syron, a doctoral student in OSU’s College of Public Health and Human Sciences and lead author of the study.

“Fortunately, Oregon’s seafood processing industry did not experience any fatalities during the study period, but the rate of injuries during that period is higher than Oregon’s all-industry average,” Syron said.

“This is an industry that merits more research and more support. Our goal is to use this information to assist seafood processing companies in the Pacific Northwest with protecting workers' safety and health.”

The study is believed to be the first to examine worker safety and health in Oregon’s seafood processing industry. The findings were published this month in the American Journal of Industrial Medicine.

OSU researchers collaborated with the Oregon Health Authority on the study. Co-authors of the paper are Laurel Kincl, an assistant professor of environmental and occupational health; Ellen Smit, an associate professor of epidemiology; environmental and occupational health doctoral student Liu Yang; and Daniel Cain, with the state of Oregon.

The study is part of a broader effort at OSU to understand and address hazards in the maritime industry.

“This important work compliments injury prevention my colleagues and I are conducting with commercial fishing fleets in the region,” said co-author Kincl, who is Syron’s advisor.

Seafood is the most-traded food commodity internationally, and the value of processed seafood products in the U.S. topped $10 billion in 2015. The dangers of commercial fishing have drawn a lot of attention over the years through reality television programs and highly-publicized disasters and safety incidents.

But there is limited research on occupational health and safety in onshore seafood processing, a food-manufacturing industry that includes cleaning, canning, freezing and other packaging and preparation. In Oregon, employment in the seafood processing industry grew steadily between 2010 and 2013, with 1,240 workers employed in the industry in 2013.

“Processing is a critical component of the seafood supply chain, and it does not get as much attention as the fishing itself,” Syron said. “Processing adds value to the product and it is also demanding work that can lead to significant injuries.”

The researchers’ review of workers’ compensation disabling claims accepted for compensation between 2007 and 2013 showed the rate of injuries among workers in the industry was more than twice that of Oregon industries overall. The most common injuries included traumatic injuries to muscles, tendons, ligaments or joints. The most frequent events that resulted in injuries were overexertion and contact with equipment or objects.

“The workers’ compensation data gives us insight into the most severe incidents and those that cost employers the most money,” Syron said.

The workers’ compensation disabling data doesn’t provide enough detail about the circumstances of the workers at the time of their injuries, so that is one area that warrants further study before prevention recommendations could be made, she said.

For her doctoral dissertation, Syron plans to examine seafood processing in Alaska, where seafood is an economically and culturally important natural resource. In that research, Syron will continue to explore injury reports in both at-sea and on-shore facilities. With interviews, she hopes to learn from companies’ safety and health managers and directors, whose roles are dedicated to protecting workers’ well-being.

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Laura Syron, 541-513-1710, laura.syron@oregonstate.edu

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Commercial fishing port in Newport, Oregon. Photo by Pat Kight, Oregon Sea Grant.

Newport's commercial fishing port

Dietary anti-cancer compound may work by influence on cellular genetics

CORVALLIS, Ore. – Researchers have discovered one of the reasons why broccoli may be good for your health.

They found that sulforaphane, a dietary compound from broccoli that’s known to help prevent prostate cancer, may work through its influence on long, non-coding RNAs. This is another step forward in a compelling new area of study on the underlying genetics of cancer development and progression.

The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.

The research provides more evidence for how these lncRNAs, which were once thought to be a type of “junk DNA” of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread.

Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or “expressed” to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated they can contribute to multiple disease processes, including cancer.

The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.

Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells.

“This could be a turning point in our understanding of how cancer may be triggered and spreads,” said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute.

“It’s obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control.”

In particular, this research showed that one lncRNA, called LINC01116, is upregulated in a human cell line of prostate cancer, but can be decreased by treatment with sulforaphane. The data “reinforce the idea that lncRNAs are an exciting new avenue for chemoprevention research, and chemicals derived from diet can alter their expression,” the scientists wrote in their study.

“We showed that treatment with sulforaphane could normalize the levels of this lncRNA,” said Laura Beaver, a research associate in the Linus Pauling Institute and College of Public Health and Human Sciences, and lead author on the study. “This may relate to more than just cancer prevention. It would be of significant value if we could develop methods to greatly slow the progress of cancer, help keep it from becoming invasive.”

The impact of diet on lncRNA expression has been largely unknown until now, the researchers said. In this study, they identified a four-fold decrease in the ability of prostate cancer cells to form colonies when LINC01116 was disrupted.

Among men, prostate cancer is the second most frequently diagnosed cancer globally, and the second leading cause of cancer-related deaths in the United States. Worth noting, the researchers said, is that an increased consumption of cruciferous vegetables such as broccoli, which are high in sulforaphane, appears to be associated with a lower risk of developing prostate cancer.

That same lncRNA, they noted, is also overexpressed in studies of several other types of cancer, including brain, lung and colon cancer. Some other lncRNAs have been found at higher levels in breast, stomach, lung, prostate cancer and chronic lymphocytic leukemia.

In other research, a knockout of the gene that encodes one type of lncRNA in mice conferred some resistance to obesity caused by a high-fat diet.

“Taken together, this literature and our own study begin to paint a picture of the important and previously unappreciated role of lncRNAs in the body’s response to diet,” the researchers wrote in the study. “These discoveries illustrate that lncRNAs can play important roles in cancer development and may be useful targets for cancer prevention, detection and treatment.”

This research was supported by the National Institutes of Health. The work included collaborators from Texas A&M Health Science Center.

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Emily Ho, 541-737-9559

emily.ho@oregonstate.edu

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Broccoli
Broccoli

Flame retardant chemicals may affect social behavior in young children

CORVALLIS, Ore. – Some chemicals added to furniture, electronics and numerous other goods to prevent fires may have unintended developmental consequences for young children, according to a pilot study released today.

Researchers from Oregon State University found a significant relationship between social behaviors among children and their exposure to widely used flame retardants, said Molly Kile, an environmental epidemiologist and associate professor in the College of Public Health and Human Sciences at OSU.

“When we analyzed behavior assessments and exposure levels, we observed that the children who had more exposure to certain types of the flame retardant were more likely to exhibit externalizing behaviors such as aggression, defiance, hyperactivity, inattention and bullying,” said Kile, the corresponding author of the study, which was published today in the journal Environmental Health.

“This is an intriguing finding because no one had previously studied the behavioral effects of organophosphate classes of flame retardants, which have been added to consumer products more recently.”

Flame retardants are found throughout the built environment in furniture, mattresses, carpeting, electronics, vehicles and more. The chemicals are added to the products and are not bound in the material, which causes them to be released into indoor environments.

Manufacturers began adding flame retardants in 1975, in response to new legislation in California designed to reduce flammability in common household items. The state updated its flammability standards in 2014, and now allows furniture manufacturers to meet the standards without adding flame retardant chemicals to their products, but the chemicals are still widely used and they linger in the indoor environment.

There are growing concerns that some flame retardants may have unintended impacts on health and development in children, and this study contributes to that body of research.

The most common types of flame retardants found in the built environment are brominated diphenyl ethers (BDEs) and organophosphate-based flame retardants (OPFRs). OPFRs emerged as an alternative to BDEs in an effort to address some of the environmental health concerns posed by BDEs, which tend to remain in the environment for long periods.

Past research has shown that both BDEs and OPFRs are linked to poorer cognitive function in children. But less is known about the relationship between the flame retardants and children’s social and emotional health, particularly during early childhood, a key developmental period for learning.

“The social skills children learn during preschool set the foundation for their success in school, and also for their social and emotional health and well-being later in life,” said Shannon Lipscomb, an associate professor and lead of the human development and family sciences program at OSU-Cascades and a co-author of the study.

For this study, the OSU research team recruited 92 Oregon children between ages 3-5 to wear a silicone wristband for seven days to measure exposure to flame retardants.

The team included Kile, Lipscomb; Megan McClelland and Megan MacDonald of the OSU College of Public Health and Human Sciences; Kim Anderson of the OSU College of Agricultural Sciences; and Andres Cardenas of the Harvard T.H. Chan School of Public Health and an OSU doctoral graduate. The research was supported by OSU’s Hallie E. Ford Center for Healthy Children and Families and the Environmental Health Science Center at OSU.

The wristbands, developed by Anderson at OSU, have a porous surface that mimics a cell, absorbing chemicals that people are exposed to through their environment. When the wristbands are returned, Anderson can screen for up to 1,200 chemicals that may accumulate. The wristband is an easy and non-invasive way to sample children’s chemical exposure.

The researchers had parents or primary caregivers complete questionnaires about socio-demographics and the home environment, and preschool teachers completed behavior assessments for each participating child. In all, researchers had complete data and wristband results for 69 children.

Their analysis showed that all of the children were exposed to some level of flame retardant. Children who had higher exposure rates of OFPRs showed less responsible behavior and more aggression, defiance, hyperactivity, inattention and bullying behaviors. Children with higher exposure to BDEs were seen as less assertive by their teachers. All of these social skills play an important role in a child’s ability to succeed academically and socially.

“We detected these links between flame retardant and children’s social behaviors while controlling for differences in family demographics, home learning environments and adversity,” Lipscomb said. “This suggests that flame retardants may have a unique effect on development apart from the effects of children’s early social experiences.”

Further study is needed to better understand the links between flame retardants and children’s social skill development, the researchers said. They plan to pursue funding for a new study that continues for a longer period of time and considers how other aspects of children’s lives might affect the impact of flame retardants on their development.

“The results of this research to date have shown potential impacts for child health and warrant a more thorough investigation,” Kile said.

“If scientists find strong evidence that exposure to flame retardants affects children’s behaviors, we can develop strategies that prevent these exposures and help improve children’s lives. This type of public health science is needed to figure out how to address the root causes of behavioral concerns that can affect children’s school readiness and overall well-being.”

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Molly Kile, 541-737-1443, molly.kile@oregonstate.edu; Shannon Lipscomb, 541-322-3137, Shannon.lipscomb@osucascades.edu

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Child wearing a wristband

Keeping Kids Safe

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https://youtu.be/pMvOKVoDA94

 

 

Fish and mercury: Detailed consumption advisories would better serve women across U.S.

CORVALLIS, Ore. – Among women of childbearing age in the U.S., fish consumption has increased in recent years while blood mercury concentrations have decreased, suggesting improved health for women and their babies, a new study shows.

The research at Oregon State University also indicates fish consumption advisories tailored to specific regions and ethnic groups would help women of childbearing age to eat in even more healthy ways, including better monitoring of mercury intake.

Food from the ocean has a unique and valuable nutritional profile. Among seafood’s many benefits are the omega-3 fatty acids that promote neurodevelopment, and the nutrients in seafood are especially important for pregnant women to pass on to developing fetuses.

But the main way people are exposed to toxic methylmercury – a mercury atom with a methyl group, CH3, attached to it – is through eating seafood. Thus the need for precise, nuanced fish consumption advisories, said Leanne Cusack of Oregon State University, the corresponding author on the study. 

Comparatively less-toxic elemental mercury enters the ocean from natural sources such as volcanic eruptions and also from human activities like the burning of fossil fuels, which accounts for about two-thirds of the mercury that goes into the water.

Once in the ocean, the mercury is methylated, diffuses into phytoplankton and passes up the food chain, accumulating along the way.

A scallop or a shrimp, for example, can have a mercury concentration of less than 0.003 parts per million. A large predator like a tuna, on the other hand, can contain roughly 10 million times as much methylmercury as the water that surrounds it and have a concentration of many parts per million.

Exactly how the mercury in the ocean becomes methylated, scientists don’t know.

Fish advisories are usually aimed at women of childbearing age because a developing fetus has greater sensitivity to the neurotoxic effects of methylmercury. Jointly, the U.S. Environmental Protection Agency and the Food and Drug Administration recommend women in that group eat two meals of low-mercury fish per week.

Using data from the ongoing National Health and Nutrition Examination Survey, Cusack’s research group looked at fish consumption patterns with regard to blood mercury levels in U.S. women of childbearing age from 1999 to 2010.

Findings were recently published in the journal Environmental Health.

Women in the coastal regions, particularly the Northeast, were found to have the highest blood mercury concentrations; women living away from the sea, especially in the inland Midwest, had the lowest.

Coastal residents also ate fish the most frequently, with the species consumed varying by region. The type of fish most often consumed was shellfish in every part of the U.S. except for the inland West and inland Midwest.

As women’s age and household income increased, so did their fish consumption frequency and blood mercury concentrations. Among ethnic groups, Asian Americans, Pacific Islanders, Alaska Natives and Native Americans ate fish the most often and showed the most mercury, and Mexican Americans consumed fish the least often and showed the smallest concentration of mercury.

“We also found total monthly fish consumption by women of reproductive age was higher than it had been in recent years, with women consuming more marine fish and shellfish but with no appreciable difference in the mean consumption of freshwater fish, tuna, swordfish and shark,” said Cusack, a postdoctoral scholar in OSU’s College of Public Health and Human Sciences.

“That’s encouraging because marine and shellfish are associated with smaller increases in blood mercury. And also encouragingly, an average women who’d eaten fish nine or more times in the previous month had lower blood mercury levels than women who’d had fish at the same rate in 1999-2000.”

The differences in consumption and mercury levels by race and region illustrate the need for tailored fish advisories, she said.

“They need to have information about fish types and quantities you can safely eat,” Cusack said. “The more detailed they can be, the better.

“The main thing is we do need to increase fish consumption in this demographic,” Cusack added. “It has been increasing since 1999, but it’s still not at the level where we want to see it. People need to start consuming fish, and advisories need to focus on the benefits of consumption and not just the risks by providing a broad range of fish that are low in methylmercury and high in omega-3’s.” 

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Steve Lundeberg, 541-737-4039

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Leanne Cusack, 541-737-5565
Leanne.Cusack@oregonstate.edu

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filets

Salmon filets

Photos show promise as dietary assessment tool, but more training needed

CORVALLIS, Ore. – Research at Oregon State University suggests that photographs of your food are good for a lot more than just entertaining your friends on social media – those pictures might help improve your health and also national nutrition policy.

But before that can happen, universities that educate the dietitians who review the photos need to provide more consistent, formal training, particularly hands-on work in food measurement and preparation and the use of computerized nutrient database systems.

A shortage of formalized, standardized training in these skills is problematic, the study shows. Results were recently published in the journal Nutrients.

The research tested the ability of 114 nutrition and dietetics students in the U.S. and Australia to identify foods and determine serving sizes by looking at photos of food on plates. They chose their food identification answers from entries in the U.S. Department of Agriculture’s Food and Nutrient Database for Dietary Studies.

The students correctly identified the nine different foods nearly 80 percent of the time but struggled with serving size; only 38 percent of the estimates were within 10 percent of the actual weight of the food, with foods of amorphous shape or higher energy density, such as ice cream, proving the hardest to assess.

Image-based dietary assessment, or IBDA, aims to reduce or eliminate the inaccuracies that commonly accompany traditional methods such as written dietary records, 24-hour dietary recalls and food frequency questionnaires.

Dietary intake information is important both to individuals using nutrition-based therapy for conditions such as diabetes and heart disease, and to entire populations for identifying nutrition and disease risk.

The U.S. Centers for Disease Control and Prevention uses information from its National Health and Nutrition Examination Survey to set policy for everything from school lunch programs to nutrition education for food-stamp recipients. The survey gathers data about dietary patterns and potential food intake inadequacies.

“We need to know where there are inadequacies in these surveys to identify nutrition and food policy and research needs,” said the study’s corresponding author, Mary Cluskey, an associate professor in OSU’s College of Public Health and Human Sciences and a registered dietitian.

With the prevalence of smartphones, photography is emerging as a means of augmenting food-intake information gathering. A pre-diabetes patient, for example, could take a picture of everything he ate for three days, and a dietitian could then analyze those photos to make recommendations for dietary improvements.

“If you’re providing me with your dietary intake information, you may not be trying to falsify the information, because you’re sincerely interested in improving your diet,” Cluskey said. “But I’m depending on your ability to recall what you ate and your ability to correctly tell me what portions and specific ingredients you had – there are all kinds of things that can make it go wrong.

“Images can facilitate your recall,” Cluskey added, “and they also prompt important questions from a dietitian: ‘Was that low-fat dressing or high-fat?’ Plus, images make dietary assessments more entertaining because people do like to take pictures of food.”

Students with a food preparation background that included cooking from recipes and frequently measuring portions performed better than those without that type of background, suggesting that future training of dietetics students should incorporate more of those types of experiences.

“We also need to work with people on their ability to take photos,” Cluskey said. “Shoot at a 45-degree angle to the food, preferably while you’re standing, and make sure you have adequate light. We want to make it as easy as possible for people to provide information that’s as accurate as possible.”

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Steve Lundeberg, 541-737-4039

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Dietary assessment photo

Vitamin E deficiency linked to embryo damage, death

CORVALLIS, Ore. – Researchers for the first time have explained how deficient levels of vitamin E can cause neurologic damage to an embryo, failure to normally develop and ultimately death – a process that in women can be one cause of miscarriage.

The research was published by scientists from Oregon State University in Free Radical Biology and Medicine. It answers some questions about the biologic activities of vitamin E that have been debated since 1922, when this essential micronutrient was first discovered, in part for its role in preventing embryonic mortality.

The research also made clear the importance of vitamin E status for any woman who is planning to, or might become pregnant, scientists said.

The study, done with zebrafish embryos, showed that severe vitamin E deficiency causes the depletion of essential fatty acids, especially the omega-3 fatty acid DHA, which has been shown to be of critical importance to health in multiple studies in recent years.

When this happens, cells use glucose to prevent or reduce damage. Lacking glucose for energy, many physical and neurologic features, especially the brain, simply don’t get built, and death can be the result. Restoration of glucose can repair some of the damage, but some physical deformities remain.

In the growing embryo of a zebrafish – which goes from a cell to a swimming fish in about five days – a severe vitamin E deficiency causes 70-80 percent mortality, the study showed.

“Vitamin E has many biologic roles, only one of which is to serve as an antioxidant,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute.

“In the growing embryo, vitamin E plays a major role in protecting essential fats such as DHA. Loss and oxidation of these fats can begin a chain reaction that involves glucose, depletes the cell of other antioxidants such as vitamin C, robs the cell of energy, and ultimately has a lethal outcome.”

When vitamin E is deficient, the embryonic brain is literally starved of necessary energy and nutrients, particularly DHA and choline, the researchers concluded in their study.

The neurological development of zebrafish is very similar to that of humans, Traber said, which make them a good model for this research.

“The importance of vitamin E in embryonic development, the very earliest days of vertebrate life, is part of what actually led to its discovery,” Traber said. “Since then we’ve learned much more about the need for this micronutrient in women. One study done in Bangladesh, for instance, showed that pregnant women with lower levels of vitamin E had double the risk of miscarriages as another group with adequate nutrition.”

Nutrition surveys suggest that about 96 percent of women in the U.S. have inadequate intakes of vitamin E in their diet, Traber said. The problem may be of even greater concern in young adult women who avoid high-fat foods and may not have a diet rich in oils, nuts and seeds, some of the foods with the highest levels of this micronutrient. The human body can create DHA from some foods, but not vitamin E.

In a human fetus, some of the most critical periods for neurologic and brain development are in the first few weeks of pregnancy. Given the difficulty of obtaining vitamin E in the diet, this would suggest that any woman who is planning to or may become pregnant should take a multivitamin with the recommended daily allowance of vitamin E and some other micronutrients, Traber said.

Collaborators on this research were from the Catholic University of Korea and the University of Southern California. The study was supported by the National Institutes of Health, the National Science Foundation and the Helen P. Rumbel endowment to the Linus Pauling Institute.

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Maret Traber, 541-737-7977

maret.traber@oregonstate.edu

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Vitamin E
Vitamin E supplements

‘Navigators’ help indigenous cancer patients overcome barriers to diagnosis, treatment

CORVALLIS, Ore. – New research shows that patient “navigators” are a valuable resource for American Indians and Alaskan Natives with cancer as they try to overcome barriers to diagnosis and care, and may offer a path to improved treatment outcomes.

The findings, recently published in the Journal of Primary Prevention, are important because American Indians and Alaskan Natives are stricken with cancer at the same rate as non-Hispanic white people but have lower five-year survivorship rates, and are more likely to die of cancer in general.

Indigenous patients in the Pacific Northwest working with a navigator were almost four times more likely to have a definitive diagnosis within a year of an abnormal screening result than patients without a navigator, the research indicated.

In addition, patients in the study praised their navigators’ ability to provide emotional and logistical support throughout the complicated and often-confusing treatment process. A navigator coordinated patients’ care between multiple providers and agencies and helped connect patients to support groups and other resources.

Megan Cahn, a postdoctoral research associate in Oregon State University’s College of Public Health and Human Sciences, was a co-author of the study along with scientists from the Northwest Tribal Epidemiology Center. The center, one of 12 in the nation, collaborates with the region’s tribes on health-related research, surveillance, training and technical assistance.

The patients in the study all received care through tribal community health clinics, which receive funding from the Indian Health Service. The project was part of a larger program by the National Cancer Institute examining the effectiveness of the patient navigator model in populations with sub-optimal cancer outcomes.

“One of the big concerns for tribal populations is that they have lower screening rates,” Cahn said. “If you don’t screen, then you don’t detect cancer until someone is showing symptoms. A big part of the program was to see if there was a way to get individuals with an abnormal screening result to get a definitive diagnosis, to shorten that window and get treatment in a timely fashion.

“We found that patients enrolled in a navigator program were 3.6 times more likely to have a definitive diagnosis within a year.”

The researchers also learned that not only was the navigator program measurably effective, the patients liked it – an important indicator of the program’s long-term success potential.

“If the patients don’t find it acceptable, the program won’t continue to work,” Cahn said.

A patient navigator was hired by the tribe at each of three tribal clinics in Idaho and Oregon, and researchers interviewed 40 patients for their perceptions of the program. The average age of the participants was 54.4, and 65 percent were female. Thirty-four of the 40 rated the navigator program as “good” or “excellent,” and one added she felt the navigator had saved her life.

In addition to the screening and diagnosis issue, the research found that the main barriers to cancer treatment cited by tribal members were physical and emotional obstacles - symptoms of the cancer itself or side effects from treatment, and “also the emotional response to the diagnosis.”

“There’s a lot of fear and anxiety and shock, and those fears often lead patients to be reluctant to continue with treatment,” Cahn said. “Some of them felt like they had received mistreatment or had been misdiagnosed, plus there were financial barriers: the cost of care and a lack of coordination regarding payment for the services.

“Other barriers were concerns around transportation – some people would have to travel several hours to get treatment, and the availability and cost of public transportation were problems. Navigators could help come up with strategies that were effective for addressing these logistical barriers.”

Sometimes a navigator would accompany a patient to an appointment and help the patient understand what the doctor was saying. Navigators also provided direct emotional support as well as referring patients to support groups.

“Patients said they valued that navigators were part of their communities and respected their culture,” Cahn said. “It made them feel like the navigators were invested in the community and the patients and their families.”

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Steve Lundeberg, 541-737-4039

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Millions of people with metabolic syndrome may need more vitamin E

CORVALLIS, Ore. – New research has shown that people with metabolic syndrome need significantly more vitamin E – which could be a serious public health concern, in light of the millions of people who have this condition that’s often related to obesity.

A study just published in the American Journal of Clinical Nutrition also made it clear that conventional tests to measure vitamin E levels in the blood may have limited accuracy compared to tests made in research laboratories, to the point that conventional tests can actually mask an underlying problem.

Vitamin E – one of the more difficult micronutrients to obtain by dietary means – is an antioxidant important for cell protection. It also affects gene expression, immune function, aids in repair of wounds and the damage of atherosclerosis, is important for vision and neurologic function, and largely prevents fat from going rancid.

Nutrition surveys have estimated that 92 percent of men and 96 percent of women in the United States fail to get an adequate daily intake of vitamin E in their diet. It is found at high levels in almonds, wheat germ, various seeds and oils, and at much lower levels in some vegetables and salad greens, such as spinach and kale.

This study was done by researchers in the Linus Pauling Institute at Oregon State University and the Human Nutrition Program at The Ohio State University, as a double-blind, crossover clinical trial focusing on vitamin E levels in people with metabolic syndrome. It was supported by the National Institutes of Health, the National Dairy Council and DSM Nutrition.

“The research showed that people with metabolic syndrome need about 30-50 percent more vitamin E than those who are generally healthy,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences, and Ava Helen Pauling Professor in the Linus Pauling Institute.

“In previous work we showed that people with metabolic syndrome had lower bioavailability of vitamin E. Our current work uses a novel approach to measure how much vitamin E the body needs. This study clearly demonstrates that people with metabolic syndrome need a higher intake of this vitamin.”

More than 30 percent of the American public are obese, and more than 25 percent of the adults in the United States meet the criteria for metabolic syndrome, putting them at significantly increased risk for cardiovascular disease and type-2 diabetes – primary causes of death in the developed world.

That syndrome is defined by diagnosis of three or more of several conditions, including abdominal obesity, elevated lipids, high blood pressure, pro-inflammatory state, a pro-thrombotic state and insulin resistance or impaired glucose tolerance.

This research, for the first time, also clearly outlined a flaw with conventional approaches to measuring vitamin E.

By “labeling” vitamin E with deuterium, a stable isotope of hydrogen, scientists were able to measure the amount of the micronutrient that was eliminated by the body, compared to the intake. The advanced research laboratory tests, which are not available to the general public, showed that people with metabolic syndrome retained 30-50 percent more vitamin E than healthy people – showing that they needed it. When the body doesn’t need vitamin E, the excess is excreted.

But in the group with metabolic syndrome, even as their tissues were taking up and retaining the needed vitamin E, their blood levels by conventional measurement appeared about the same as those of a normal, healthy person.

“We’ve discovered that vitamin E levels often look normal in the blood, because this micronutrient is attracted to high cholesterol and fat,” Traber said. “So vitamin E can stay at higher levels in the circulatory system and give the illusion of adequate levels, even as tissues are deficient.

“This basically means that conventional vitamin E blood tests as they are now being done are useless.”

The findings support the conclusion that people with metabolic syndrome have higher levels of oxidative and inflammatory stress, scientists said in their conclusion, and require more antioxidants such as vitamins E as a result.

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Maret Traber, 541-737-7977

maret.traber@oregonstate.edu

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Air pollution and lack of physical activity pose competing threats to children in China

CORVALLIS, Ore. – Children and adolescents in mainland China are facing two serious and conflicting public health threats: ongoing exposure to air pollution and an increasingly sedentary lifestyle with little regular physical activity outside school.

Health workers and policymakers need to find ways to address both of these issues so that

children can be more physically active without suffering the health risks caused by exposure to air pollution, an Oregon State University researcher suggests in a new commentary published this month in The Journal of Pediatrics

“The question is how do we balance the virtues of physical activity with the hazards of air pollution?” said Brad Cardinal, a kinesiology professor in the College of Public Health and Human Sciences at Oregon State University and a national expert on the benefits of physical activity. “Ultimately, we have to find ways for people to stay active despite the air pollution.”

Many cities and countries around the world grapple with air pollution issues, but there is particular concern for children growing up in China in part because they tend to commute more on foot or bike and their playgrounds and sports fields are often found near busy streets or highways, Cardinal said. The impacts of air pollution contributed to 1.2 million deaths in 2010. 

At the same time, very few Chinese children today are participating in moderate or vigorous physical activity outside of school, and the number of overweight and obese children in China has more than doubled in the last 25 years.

Children are particularly susceptible to adverse health impacts from both short- and long-term exposure to air pollution, in part because they have higher rates of respiration and tend to take shallower breaths. Air pollution has been associated with increases in asthma, chronic cough and other respiratory problems in children that are likely to be exacerbated by heavy breathing from vigorous exercise, Cardinal said. 

So how do public health officials approach these competing challenges? Cardinal and his co-author, Qi Si of Zhejiang University in China and a former visiting scholar at OSU, suggest the two problems should be addressed together.

They recommend four urgent steps for health officials and policymakers who are grappling with these issues: 

  • Increase awareness among parents, children, health workers, educators, and policymakers on the causes and impacts of air pollution on children and adolescents, as well as the potential harm when coupled with outdoor physical activity
  • Add air quality systems at school sites, so pollution can be measured when and where children are engaging in physical activity
  • Adjust the intensity of outdoor physical activity during the school day on the basis of air pollution monitoring results
  • Educate children about exercising in polluted environments, including instruction to stop activity when they notice problems such as coughing, chest tightness or wheezing

Since schools are the base for much of the physical activity of today’s children, they are a critical piece in addressing both issues, Cardinal said. Monitoring the micro-climate at a school would provide better, more localized information for school officials making decisions about whether children should be outside exercising or at what level of intensity. 

“Doing some kind of physical activity, even if it is not as vigorous, is still better than having no physical activity for the children,” he said.

Clothing accessories or fitness equipment could also be designed to help protect children from pollution during outdoor play activities on days when air quality levels were low, he said.

“The goal is to get people thinking about these complex problems and real-world solutions,” Cardinal said. “The hope is that someone will innovate appropriate solutions for addressing both of these problems.” 

The National Health and Fitness Technology Research Key Laboratory of Zhejiang Province provided support for this project.

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Brad Cardinal, 541-737-2506, brad.cardinal@oregonstate.edu

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