Lateral elbow pain (LEP) due to tendinosis is one of the most common musculoskeletal pains of the upper limbs, yet there is no satisfactory treatment. This study was an international, prospective, multi-center, randomized, controlled, clinical trial to evaluate the efficacy of acupuncture compared to sham laser in the treatment of LEP (1). The results found significant differences in DASH score between the two groups. Significant differences were also found for secondary outcome measures for VAS pain. There were no severe adverse events. The authors findings suggest that acupuncture has a moderate efficacy in the treatment of LEP. The authors conclude that acupuncture was shown to be efficacious in improving the function of the arm associated with lateral elbow tendinosis. Both the DASH score and the VAS pain on two occasions (at rest and during motion) showed a significant change over time indicating acupuncture as a potential treatment for LEP due to tendinosis.

The authors review knowledge concerning public presentations for depression (1). These presentations impact illness beliefs and may influence public stigma, self-stigma, and depression literacy. They provide a critical review of messages, images, and information concerning depression's causes, continuum conceptualization, timeline, curability, coping/treatment regimen, and strengths. To provide data regarding the prevalence of particular presentations, they conducted a content analysis of 327 videos about depression representative of material on the YouTube social media platform. YouTube presentations of depression indicate that depression: 1) is caused by either biological (49.5%) or environmental (41.3%) factors; 2) is a categorical construct (71%); 3) is treatable, with 61% of relevant videos presenting recovery as "likely"; 4) is chronic, found in 76% of videos mentioning timeline; 5) is recurrent (32.5%); 6) is mostly treated via medication (47.4%) or therapy (42.8%), although diet/exercise (28.4%) and alternative treatments (22.6%) are commonly endorsed; and 7) is rarely associated with strength (15.3%). Nearly one-third of videos were uploaded by non-professional vloggers, while just 9% were uploaded by mental health organizations. The authors discuss how these presentations may influence stigmatizing attitudes and depression literacy among people with and without depression and suggest future research directions to better understand how to optimize public presentations.

Although medical requirements are urgent, no effective intervention has been proven for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). To facilitate the development of new therapeutics, the authors systematically reviewed the randomized controlled trials (RCTs) for CFS/ME to date (1). RCTs targeting CFS/ME were surveyed using two electronic databases, PubMed and the Cochrane library, through April 2019. The results showed that among 513 potentially relevant articles, 55 RCTs met inclusion criteria; these included 25 RCTs of 22 different pharmacological interventions, 28 RCTs of 18 non-pharmacological interventions and 2 RCTs of combined interventions. Eight interventions showed statistical significance: 3 pharmacological (Staphypan Berna, Poly(I):poly(C12U) and CoQ10 + NADH) and 5 non-pharmacological therapies (cognitive-behavior-therapy-related treatments, graded-exercise-related therapies, rehabilitation, acupuncture and abdominal tuina). However, there was no definitely effective intervention with coherence and reproducibility. The authors conclude that this systematic review integrates the comprehensive features of previous RCTs for CFS/ME and reflects on their limitations and perspectives in the process of developing new interventions.

Herbal remedies are becoming increasingly popular for the treatment of depression. Recently, accumulating evidences reveal a positive effect of saffron (Crocus sativus L.) in relieving depressive symptoms. The objective of this meta-analysis was to assess the safety and efficacy of saffron in treating mild to moderate depression by synthesizing all available data (1). Relevant studies were retrieved from electronic databases and cross-checking of reference lists. The results showed that twelve studies were included in the meta-analysis. Overall results showed that saffron possessed better efficacy in the improvement of depressive symptoms when compared with placebo, whereas saffron was as effective as synthetic antidepressants. No significant difference was detected in the incidence of adverse effects between saffron and placebo or between saffron and antidepressants. The authors conclude that saffron could be considered as an alternative to synthetic antidepressants in the treatment of mild to moderate depression.

Lupin is a novel food ingredient, rich in protein and fibre with negligible sugar and starch, which can be incorporated into various foods to reduce glycaemic load. Regular consumption of lupin-enriched foods may be a novel and easily achievable means of reducing overall glycaemic load and improving glycaemic control in diabetes. The authors of this study tried to determine whether regular consumption of lupin-enriched foods can improve glycaemic control and lower blood pressure in people with type 2 diabetes mellitus (1). Fourteen men and 8 women (mean age 58.0 ± 6.6 years and BMI 29.0 ± 3.5 kg m-2) with type 2 diabetes mellitus were recruited from the general population to take part in a double-blind, randomised, controlled cross-over study. Participants consumed lupin or control foods for breakfast and lunch every day, and for dinner at least 3 days per week during the 8-week treatment periods. Lupin-enriched foods consisted of bread, pasta, Weetbix™ cereal and crumbs, with energy-matched control products. Treatments were completed in random order with an 8-week washout period. The results showed that seventeen participants completed both treatment arms, with all 22 participants (14 males, 8 females) analysed on an intention-to-treat basis. Eight weeks consumption of lupin-enriched food had no significant effect on mean blood glucose levels or post-prandial blood glucose levels. There was no effect on home systolic or diastolic blood pressure and heart rate, and no effect on body weight throughout the treatment periods. The authors conclude that regular consumption of lupin-enriched foods had no significant effect on glycaemic control or blood pressure in people with type 2 diabetes mellitus.

This study discussed the role of the microbiome in depression (1). Microorganisms can be found in virtually any environment. In humans, the largest collection of microorganisms is found in the gut ecosystem. The adult gut microbiome consists of more genes than its human host and typically spans more than 60 genera from across the taxonomic tree. In addition, the gut contains the largest number of neurons in the body, after the brain. In recent years, it has become clear that the gut microbiome is in communication with the brain, through the gut-brain axis. A growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder (MDD). In this review, the interplay between the microbiome and MDD is discussed in three facets. First, we discuss factors that affect the onset/development of MDD that also greatly impinge on the composition of the gut microbiota-especially diet and stressful life events. There is  evidence suggesting that the microbiota is altered in MDD, and the authors discuss why the microbiota should be considered during MDD treatment.

Several studies have established a relationship between low serum vitamin D levels and the onset of asthma in childhood. In this study, the authors aim to assess the relationship between vitamin D and asthma (1). This study included 29 mild and 30 moderate persistent asthma and 38 healthy control group. Evaluation of the three groups was carried out in respect of serum vitamin D levels, Respiratory Function Test (RFT), and Exercise Provocation Test (EPT). The two asthma groups were also examined using the Asthma Control Test (ACT) and Nitric Oxide in Exhaled Breath (FeNO) level. The results showed that the vitamin D levels of the mild and the moderate persistent asthma groups were determined to be lower than the vitamin D levels of the control group. A significant negative correlation was determined in all cases between the vitamin D levels and the broncho-reversibility percentage. The negative correlation between the vitamin D levels and the broncho-reversibility percentage was more evident in the moderate persistent asthma group. In the moderate persistent asthma group, a significant positive correlation was determined between the lowness of the maximum forced expiratory volume in EPT and a low vitamin D level. The ACT scores were lower, and the FeNO levels were higher in the moderate asthma group compared to the mild asthma group. The authors conclude that the findings showed that low serum vitamin D levels were observed more often in children with asthma, and there was a correlation with increased broncho-reversibility in the RFT and increased bronchial hyper-reactivity in the EPT.

The ketogenic diet pros and cons

This is a review article on the ketogenic diet (1). Diets have been at the center of animated debates for decades and many claims have been made in one direction or the other by supporters of opposite camps, often with limited evidence. At times emphasis has been put on a single new aspect that the previous diets had overlooked and the new one was to embrace in order to improve weight loss and well-being. Unfortunately, very few randomized clinical trials involving diets have addressed the combined question of weight loss and cardiovascular outcomes. The recently introduced ketogenic diet requires a rigorous limitation of carbohydrates while allowing a liberal ingestion of fats (including saturated fats) and has generated a flurry of interest with many taking the pro position and as many taking the cons position. The ketogenic diet causes a rapid and sensible weight loss along with favourable biomarker changes, such as a reduction in serum hemoglobin A1c in patients with diabetes mellitus type 2. However, it also causes a substantial rise in low density lipoprotein cholesterol levels and many physicians are therefore hesitant to endorse it. In view of the popular uptake of the keto diet even among subjects not in need of weight loss, the authors conclude that there is some preoccupation with the potential long-term consequences of a wide embrace of this diet by large segments of the population. On the contrary, numerous lines of evidence show that plant-based diets are associated with reduction in oncological and cardiovascular diseases and a prolonged life span.

Hydrotherapy for balance and knee strength in patients with stroke

The objective of this study was to compare the effects of hydrotherapy and land-based conventional therapy (CT) on postural balance and knee strength in stroke patients (1).The results showed that eleven articles were included. Pooled results showed that hydrotherapy was more beneficial in stroke patients on BBS, TUG, and KE torque than CT. In subgroup analysis according to stroke-onset duration, hydrotherapy for chronic stroke patients exhibited significant effectiveness on BBS; no significant effect was observed in subacute stroke patients. The authors conclude that stroke patients showed improvement in postural balance and paretic knee extensor strength with hydrotherapy. Hydrotherapy exhibited significant effects on improving postural balance in chronic patients than in subacute patients.

Australian health service utilization in those with cancer

The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population (1). The results showed that the population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. The authors conclude that the population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation.

Naturopathic Medicine for Gastrointestinal complaints

Functional gastrointestinal disorders (FGID) affect more than one-third of the general population and contribute a considerable burden on the health and wellbeing of the community and the economy. This study aims to examine the treatment approaches and outcomes of naturopathic management of individuals presenting with a non-specific FGID (1). This study presents clinical case studies of patients being treated by a naturopath for a functional gastrointestinal disorder. The care was provided by two different student practitioners under the supervision of an industry qualified mentor within a multidisciplinary academic clinic at the Endeavour College of Natural Health. The results showed that clinical notations partially correlate to Jane's outcomes measured by gastrointestinal rating scale scores, which remain stable. Significant changes in Rona's gastrointestinal rating scale scores equate to only generalizable minimal clinical notations. The authors conclude that the holistic and individualised approach core to naturopathic medicine practice is also informed by traditional methods, research evidence and the pragmatic needs of the patient. The emphasis within naturopathic treatment approaches on dietary changes and lifestyle prescription alongside other ingestive therapies such as herbal and nutritional medicine underscores the need for clinical research designs which support evaluation of complex interventions in real-world settings.

Gestational Diabetes and Vitamin D

Vitamin D plays an important role in glucose tolerance by stimulating insulin secretion and evidences suggest a contradictory result on the association between vitamin D status and risk of developing gestational diabetes mellitus (GDM). This meta-analysis was undertaken to find out the joined effect of vitamin D status on the risk of effect GDM considering previously published articles (1). Data were collected through literature search using electronic databases to retrieve relevant published research articles using various combinations of the following keywords, "vitamin D," "vitamin D deficiency," "cholecalciferol," "25-hydroxyvitamin D," "25(OH) D," "gestational diabetes mellitus," and "GDM." A total of 36 studies including 7,596 GDM cases and 23,377 non-GDM controls were involved in this study. Overall, pooled meta-analysis showed that pregnant women diagnosed with GDM have 18% higher risk of GDM risk when compared with controls. Subgroup analysis showed significant results with age more than 30 years, Asian and European regions, and case-control, cross-sectional, and nested case-control study design. The authors conclude that low concentration of vitamin D is associated with the development of GDM.
 

Succeeding with Exercise Therapy in patients with intermittent claudication

Supervised exercise therapy is the first step in treatment of intermittent claudication. However, adherence to supervised exercise therapy is low. Limited access and reimbursement issues are known reasons, though lack of motivation is often leading. Behavioral determinants influencing motivation and thus adherence to supervised exercise therapy remain to be investigated. In this study the authors sought to determine which behavioral determinants would be of influence on the long-term adherence of supervised exercise therapy (1). The results showed that 108 (54%) patients returned their questionnaire. A total of 79% patients followed supervised exercise therapy. Patients who increased their walking distance after supervised exercise therapy have significantly greater knowledge (p=0.05), positive attitude (p=0.03) and lower negative attitude (p=0.01). Patients with a higher self-efficacy remained significantly more active after participating in supervised exercise therapy (p=0.05). The authors conclude that increasing the determinants knowledge, attitude and self-efficacy will improve adherence to supervised exercise therapy and result in delayed claudication onset time.

Acupuncture in Hospitalized Patients with Schizophrenia

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA + ECT, n = 81) were identified (1). EA and ECT were conducted for 5 and 3 sessions per week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA + ECT groups had markedly greater clinical response rate than controls on SAPS and on SANS. A significantly greater response rate on SANS than controls was also observed in the EA group. EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia.

Whole and Refined Grains and Health

This study discussed the research on whole and refined grains (1). Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article provided arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.