Muni Rubens

Political and Medical Views on Medical Marijuana and its Future

The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of marijuana has always been political, rather than scientific. Federal law has barred the use of medical marijuana though 18 state governments and Washington, DC, support the medical use of marijuana. Unfortunately, not many studies exist on medical marijuana to back these laws and policies. The judiciary, on the other hand, has elicited a diverse response to medical marijuana through its rulings over several decades. Some rulings favored the federal governments opinion, and others supported the larger public view and many state governments with legalized medical marijuana. Public opinion on legalizing medical marijuana has always favored the use of medical marijuana. The movement of scientific knowledge of medical marijuana follows an erratic, discontinuous pathway. The future place of medical marijuana in U.S. society remains unknown. The three forces—scientific knowledge, social-political acceptance, and laws—play a role in the direction that medical marijuana takes in society. Overcoming political-social forces requires a concerted effort from the scientific community and political leaders. The results of scientific research must guide the decisions for laws and medical use of marijuana. This article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana by tracing the past history of medical marijuana with its bumpy pathway in the social-political arena.

HIV Vaccine: Recent Advances, Current Roadblocks, and Future Directions

HIV/AIDS is a leading cause of mortality and morbidity worldwide. In spite of successful interventions and treatment protocols, an HIV vaccine would be the ultimate prevention and control strategy. Ever since identification of HIV/AIDS, there have been meticulous efforts for vaccine development. The specific aim of this paper is to review recent vaccine efficacy trials and associated advancements and discuss the current challenges and future directions. Recombinant DNA technologies greatly facilitated development of many viral products which were later incorporated into vectors for effective vaccines. Over the years, a number of scientific approaches have gained popularity and include the induction of neutralizing antibodies in late 1980s, induction of CD8 T cell in early 1990s, and combination approaches currently. Scientists have hypothesized that stimulation of right sequences of somatic hypermutations could induce broadly reactive neutralizing antibodies (bnAbs) capable of effective neutralization and viral elimination. Studies have shown that a number of host and viral factors affect these processes. Similarly, eliciting specific CD8 T cells immune responses through DNA vaccines hold future promises. In summary, future studies should focus on the continuous fight between host immune responses and ever-evasive viral factors for effective vaccines.

Selenium and vitamin E for prostate cancer--justifications for the SELECT study.

There are several studies that relate oxidative damage as possible mechanism for many cancers. Many studies have also shown that anti-oxidants like selenium and vitamin E decrease the risk for prostate cancer. The main objective of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) study was to look for the benefits of selenium and vitamin E supplementation on prostate cancer. The study had a large sample size, stringent experimental conditions, very long duration, standardized laboratories for biochemical analyses and other factors that contribute to high external validity. The SELECT study failed to show any significant risk reduction for prostate cancers ascribable to selenium and vitamin E supplementations. Because of these conflicting results, many researchers argue about the methods used, supplementations administered (selenium and vitamin E) and indicators used for assessing levels of supplementations. We reviewed many epidemiological studies, clinical trials, and pre-clinical studies. With corroborative evidences we justify that SELECT study has a sound methodology and rationale. In lieu of the contrary results of the select study, researchers should focus on the probable mechanisms for these contrary findings and continue their search for newer and effective agents for prevention of prostate cancer.

Proficiency in Condom Use Among Migrant Workers

&NA; Consistent and correct use of condoms is important to prevent the transmission of HIV and other sexually transmitted diseases. We evaluated condom use skills on an 11‐point scale in which participants were observed placing a condom on a penile model. Participants were 375 sexually active African American and Hispanic migrant workers. For analysis, subjects were divided into skilled and unskilled groups by a median split of the condom use skills score. Sexual risk behaviors were analyzed between condom use skilled and unskilled groups and level of condom use skills between African Americans and Hispanics. African Americans showed better skills in using condoms, and participants in the condom‐use skilled group used condoms more frequently. Finally, a logistic regression was conducted to find predictors of condom use skills. Significant predictors were ethnicity, language, and assistance‐related social support (obtaining advice from people who could provide tangible assistance).

Systemic immune activation in HIV and potential therapeutic options

Abstract Context: Advancement in HIV treatment has evolved over the last two decades with the discovery of new drugs and approaches. Studies have demonstrated that HIV-infected individuals have elevated immune activation even during effective antiretroviral therapy. Persistently elevated immune activation has been one of the main obstacles against developing an effective approach for curing HIV. Objective: This review examines the mechanism of microbial translocation in HIV-infected individuals and currently investigated potential therapeutic approaches. Methods: We searched PubMed and Medline for peer-reviwed articles and recent HIV/AIDS conference abstracts and papers. Narrative review method was used since the objectives of the study were mechanism of microbial translocation and mechanism of action of multiple drugs against it. Results: Microbial translocation occurs as a result of the disruption of epithelial barrier and immunological dysfunction within the intestinal tract due to defective tight junctions, loss of TH17 type CD4+ T cells, impaired liver architecture, and depletion of intestinal myelomonocytic cells. Potent and effective way to intervene microbial translocation is to target the mechanism of actions involved in microbial translocation by restoration of beneficial microbiata with supplemental probiotics/prebiotics, increased clearance of microbial products from systemic circulation with targeted antibodies and restoration of intestinal integrity with antibiotics. Conclusions: Number of promising drug molecules against microbial translocation are currently under various stages of trials and the results of these trials will hopefully contribute significantly toward effective therapeutic intervention. However, studies also need to explore the effect of combination drugs to abrogate microbial translocation.

Health promotion and disease prevention strategies for today's physicians.

Abstract:The majority of preventable diseases in both developed and developing countries could be strategically controlled by effectively implementing existing health promotion and disease prevention (HPDP) interventions. An important juncture for the implementation of risk-reduction strategies is the point of interaction between health care providers and patients during their scheduled visits. This article targets strategies for physicians to effectively implement HPDP interventions in a clinical setting. The factors that improve delivery of HPDP interventions are discussed briefly. We subsequently introduce and discuss the conceptual framework for enhanced patient education, which is based on the information-motivation-behavioral skills model and the health belief model. The article also describes an adapted patient-practitioner collaborative model for HPDP. This adapted model may serve as a blueprint for physicians to effectively execute HPDP interventions during clinical encounters. The recommended models and our conceptual frameworks could have limitations which need to be field tested.

A review of 5-HT transporter linked promoter region (5-HTTLPR) polymorphism and associations with alcohol use problems and sexual risk behaviors.

Alcohol use and sexual risk behaviors are multidimensional phenomena involving many genetic and environmental factors. 5-HT transporter linked promoter region (5-HTTLPR) polymorphism constitutes an important factor affecting alcohol use problems and risky sexual behaviors. This paper narratively reviews studies on 5-HTTLPR polymorphism and its associations with alcohol use problems and sexual risk behaviors. We searched the electronic databases, PubMed, Ovid, and Google Scholar for articles using MeSH terms. Relevant articles were reviewed and eligible articles were selected for the study. Many studies have reported a significant but moderate association between 5-HTTLPR polymorphism and alcohol use problems. These studies have implicated the presence of at least one S allele to be associated with significant increases in alcohol use problems. Similarly, some studies associate the S allele with increased sexual risk behaviors. Effective alcohol cessation initiatives and STI/HIV prevention programs should be modified to account for 5-HTTLPR polymorphism before planning interventions; genetic effects could moderate the intervention effect.

Risk of Second Cancers in Merkel Cell Carcinoma: A Meta-Analysis of Population Based Cohort Studies

The risk of second cancers in Merkel cell carcinoma (MCC) remains uncertain since risk estimates vary worldwide. The global MCC population is growing and there is a demand for better knowledge of prognosis of this disease. The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE search engines were searched for the relevant literature between January 1999 and September 2014 by use of explicit search criteria. The main outcome was second malignancies associated with MCC patients measured by standardized incidence ratios (SIRs) or other estimates of risks. Five papers fulfilled the inclusion criteria and reported SIRs of second cancer in MCC which varied from 1.07 to 2.80. Performing meta-analysis using random effects model revealed that there was an increased risk for second malignancies due to MCC (SIR, 1.52; 95% CI, 1.10–2.11). There was a significant increase in risk for malignant melanoma (SIR, 3.09; 95% CI, 2.02–4.73) as compared to all common second malignancies among the studies. Updated knowledge about risk of second malignancies in MCC will help in better assessment of the disease prognosis and will help in optimizing the medical and surgical treatment, radiotherapy, follow-up, and surveillance procedures.

A Needs Assessment of Health Department Employees in Puerto Rico and Florida

Public health training centers were established to enhance competencies in skills required to meet 21st-century public health challenges. In 2011, the Puerto Rico–Florida Public Health Training Center conducted surveys to assess the training needs of two populations of public health workers serving Hispanic communities: Florida Department of Health employees and workers at the regional and central offices of the Puerto Rico Department of Health. The two surveys were similar, but not identical in content and administration. A 52.6% response rate was achieved in the Commonwealth of Puerto Rico, where limited computer access necessitated use of a pen-and-paper survey. A 20.7% response rate was achieved in Florida, where an online survey was used and incomplete responses were problematic. Puerto Rico respondents (n = 1,414) were similar in age (Mdn age = 48 years) to Hispanic Florida respondents (n = 546, Mdn age =45 years). They also reported higher levels of academic achievement and more years of experience in public health. Nevertheless, self-assessed public health competency scores were in the low- to mid-range for Hispanic respondents in both locales. Although self-assessed training priorities differed, Hispanic employees in both jurisdictions preferred hands-on and face-to-face training to distance learning. Findings indicate a need for training based on adult learning theory, targeted to entry-level employees, and addressing the top five self-assessed training needs, especially health promotion and disease prevention and public health law and policy, which emerged as priority training areas in both survey populations.

Caffeine and Insomnia in People Living With HIV From the Miami Adult Studies on HIV (MASH) Cohort

&NA; We explored the relationship between caffeine consumption, insomnia, and HIV disease progression (CD4+ T cell counts and HIV viral loads). Caffeine intake and insomnia levels were measured using the Modified Caffeine Consumption Questionnaire and the Pittsburgh Insomnia Rating Scale (PIRS) in 130 clinically stable participants who were living with HIV, taking antiretroviral therapy, and recruited from the Miami Adult Studies on HIV cohort. Linear regressions showed that caffeine consumption was significantly and adversely associated with distress score, quality‐of‐life score, and global PIRS score. Linear regression analyses also showed that global PIRS score was significantly associated with lower CD4+ T cell counts and higher HIV viral loads. Caffeine could have precipitated insomnia in susceptible people living with HIV, which could be detrimental to their disease progression states.