Jodi C. McDaniel

Fish oil supplementation alters levels of lipid mediators of inflammation in microenvironment of acute human wounds

Chronic wounds often result from prolonged inflammation involving excessive polymorphonuclear leukocyte activity. Studies show that the ω‐3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in fish oils generate bioactive lipid mediators that reduce inflammation and polymorphonuclear leukocyte recruitment in numerous inflammatory disease models. This studys purpose was to test the hypotheses that boosting plasma levels of EPA and DHA with oral supplementation would alter lipid mediator levels in acute wound microenvironments and reduce polymorphonuclear leukocyte levels. Eighteen individuals were randomized to 28 days of either EPA+DHA supplementation (Active Group) or placebo. After 28 days, the Active Group had significantly higher plasma levels of EPA (p<0.001) and DHA (p<0.001) than the Placebo Group and significantly lower wound fluid levels of two 15‐lipoxygenase products of ω‐6 polyunsaturated fatty acids (9‐hydroxyoctadecadienoic acid [p=0.033] and 15‐hydroxyeicosatrienoic acid [p=0.006]), at 24 hours postwounding. The Active Group also had lower mean levels of myeloperoxidase, a leukocyte marker, at 12 hours and significantly more reepithelialization on Day 5 postwounding. We suggest that lipid mediator profiles can be manipulated by altering polyunsaturated fatty acid intake to create a wound microenvironment more conducive to healing.

Effect of n-3 Oral Supplements on the n-6/n-3 Ratio in Young Adults

Epidemiological studies show that n-6/n-3 polyunsaturated fatty acid (PUFA) ratios have risen dramatically in Western diets and are associated with numerous chronic inflammation-related diseases. More balanced ratios are linked to less inflammation. This study examines the effects of adding oral supplements containing n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to diets of healthy young adults on plasma n-6/n-3 ratios. Thirty volunteers are randomly assigned to one of two groups: experimental group, EPA (1.6 g/day) and DHA (1.2 g/day); and the control group, mineral oil (2.4 ml/day). Plasma fatty acids, nutrients from foods, and anthropometric measures are evaluated at baseline and at the Week 4 endpoint. The mean (±SD) n-6/n-3 ratio for the experimental group is significantly lower (6.3 ± 1.6) than the placebo group (16.8 ± 3.5) by study completion. The results suggest that more balanced n-6/n-3 ratios may be achieved efficiently in healthy, young adults with supplements containing EPA and DHA.

Are young adults following the dietary guidelines for Americans

AbstractAn analysis of lifestyle choices of Midwestern young adults suggests that this sector does not heed evidence-based guidelines for reducing risk of chronic diseases, which are the most common, costly, and preventable of all health problems. Nurse practitioners who consistently promote the guidelines may improve long-term health in this subpopulation.

Nutritional profile of older adults with chronic venous leg ulcers: A pilot study

The purpose of this cross-sectional descriptive pilot study was to describe daily intake of select nutrients important for efficient wound healing and general health in a sample of older adults (64.25 ± 9.49 years of age) with chronic venous leg ulcers (CVLUs; N = 12), compared to recommended dietary allowances (RDA). Anthropometric data were also collected. Compared to RDA, participants on average consumed lower vitamin C (60.03 ± 49.73 mg/d) and higher sodium (3197.07 ± 1455.04 mg/d), sugar (181.21 ± 115.45 g/d), and saturated fat (33.75 ± 1.06 g/d). They also demonstrated a relatively high plasma n-6/n-3 polyunsaturated fatty acid ratio, a biomarker of inflammation (11.25 ± 1.99). The mean body mass index indicated extreme obesity (41.48 ± 11.47). A multidisciplinary treatment approach that includes routine dietary assessments followed by tailored dietary interventions may improve wound healing and long-term health outcomes in this population.

EPA + DHA supplementation reduces PMN activation in microenvironment of chronic venous leg ulcers: A randomized, double‐blind, controlled study

Sustained high levels of activated polymorphonuclear leukocytes (PMNs) and PMN‐derived proteases in the microenvironment of chronic venous leg ulcers (CVLUs) are linked to chronic inflammation and delayed healing. Uncontrolled PMN activity eventually destroys newly developed tissue and degrades critical growth factors. The bioactive components of fish oil (n‐3 eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) have strong inflammation‐resolving actions and have been shown to assuage PMN activity, but have not been tested in CVLU patients. This randomized controlled study compared the effectiveness of oral EPA + DHA therapy to a placebo for reducing PMN activation in CVLU microenvironments. At Days 0, 28, and 56, markers of PMNs (CD15) and activated PMNs (CD66b), and levels of PMN‐derived proteases human neutrophil elastase and matrix metalloproteinase‐8 were measured in CVLU fluid from patients receiving standard compression therapy and (1) EPA + DHA therapy (n = 16) or (2) placebo (n = 19). By Day 56, the EPA + DHA Group had a significantly lower percentage of CD66b+ cells in CVLU fluid compared to Day 0 (p = 0.02) and to Day 28 (p = 0.05). Importantly, there were downward trends in levels of both matrix metalloproteinase‐8 and human neutrophil elastase over time in the EPA + DHA Group, which also demonstrated greater reductions in wound area by Day 28 (57% reduction) and Day 56 (76% reduction) than the Control Group (35% and 59%, respectively). Moreover, reductions in wound area had significant negative relationships with CD15+ cells in wound fluid at Days 28 (p = 0.008) and 56 (p < 0.001), and CD66b+ cells at Days 28 (p = 0.04) and 56 (p = 0.009). The collective findings provide supplemental evidence that high levels of activated PMNs in CVLU microenvironments inhibit healing, and suggest that EPA + DHA oral therapy may modulate PMN activity and facilitate healing of CVLUs when added to standard care regimens.

Health Literacy Deficits Found Among Educated, Insured University Employees:

Evidence has consistently shown that low/limited health literacy (HL) is associated with negative health consequences and higher costs for individuals and society. To generate internal data for employee training and health/wellness programming, an HL assessment of 120 university employees was conducted using the Newest Vital Sign (NVS), a valid and reliable clinical screening tool that asks individuals to interpret a nutrition label. Sociodemographic data were collected and time to administer the NVS tool was also measured. Even in this employed, well-educated sample (mean years of formal education was 16.6 years), 17% had scores indicating limited or possibly limited HL. Findings have implications for occupational training and health providers and programs. Even a well-educated workforce benefits from addressing HL challenges or situational issues with universal strategies. This project supports initiatives to assist employees better navigate, understand, and use health information and services to improve their health.

Exemplars of complex assessment and care for hospitalized older adults: Genital herpes infection

Hospitalized older adults oftenpresentwithmore thanone acute illness and/or multiple chronic conditions. Their assessment and care requires nurses and inter-professional team members to be “tuned in” to complex conditions and trajectories. The herpes simplex virus (HSV) is an emerging/re-emerging infection and chronic condition that contributes to the complexity of care for older people during acute hospitalization and across care settings. The estimated current incidence (more than a half billion people worldwide) and future global impact of genital herpes infection is staggering. Nursing care during hospitalization includes prevention of transmission, wound care, anti-viral treatment, patient-family education and counseling, and follow-up care planning. In this article, guest contributors, Dr. JodiMcDaniel andMichele Giovannelli, present the special considerations regarding HSV infection in wound assessment among hospitalized older adults as exemplars of complex acute care in geriatric nursing. Two case exemplars illustrate the problem, presentation, and treatment of HSV wounds. Wounds that develop unintentionally in older adults during hospitalization often have serious and costly health consequences. Both patient and environmental factors can promote their occurrence. For example, aging skin is associated with a decline in skin barrier function, sensory perception, thermoregulation and immunologic responsiveness.1 These changes can collectively contribute to an increased risk for skin tears, skin infections and pressure ulcers during hospitalization when patients are less mobile and/or require assistancewith activities of daily living.1 Chronic