Commonly Consumed Fruits
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He is a reviewer and an editorial board member of many scientific journals and is also a member of many societies among which are the Canadian Association for Global Health (CAGH) and Solid Waste Association of North America (SWANA).",coeditorOneBiosketch:"Dr. Abisoye Oyeyemi won the J.D. Soleye’s Prize for being the best candidate in the 2010 Parts II FMCPH Examinations with the best dissertation and also won the Adetokunbo O. Lucas Prize for the best candidate in 2010 Part II FMCPH Examinations. Between 2003 and 2005, Dr. Oyeyemi served as Site Supervisor (rural site) for the first-ever PMTCT project in Bayelsa State – a partnership between Bayelsa State Government, UNICEF, and Nigerian Agip Oil Company.",coeditorTwoBiosketch:"Dr. Sawyerr is a member of the African Academy of Environmental Health Professionals and the Alliance of Hazardous Materials Professionals, the U.S.A. He has authored over seven training manuals for Environmental Health Science, has published in over eighty-seven scientific journals, and has attended several scientific conferences both nationally and internationally.",coeditorThreeBiosketch:"Dr. Adias is a Fellow of the Institute of Biomedical Science (FIBMS), London, UK. His current research interest is focused on Transfusion immunology, safety, alternatives, and hematology of infectious diseases. Recent publications have included articles in Journals such as the Journal of Blood Medicine, Transfusion Clinique et Biologique, Pathology and Laboratory, and Medicine International amongst others.",coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338653",title:"Dr.",name:"Morufu",middleName:"Olalekan",surname:"Olalekan Raimi",slug:"morufu-olalekan-raimi",fullName:"Morufu Olalekan Raimi",profilePictureURL:"https://mts.intechopen.com/storage/users/338653/images/system/338653.jpg",biography:"Sanitarian RAIMI, Morufu Olalekan 15 years’ career includes expertise in environmental health ethics and policy, emergency preparedness and response, environmental health informatics, environmental auditing, monitoring and scanning, Health Impact Assessment (HIA). A registered and licences environmental health officer. Sanitarian Raimi Morufu Olalekan received his M.Phil in Environmental Health Science from Kwara State University in August 2018 and MSc in Environmental Health Management from the University of Uyo in March 2017, Diploma in Environmental Health from Public Health Training Institute and Bsc in Geography and Environmental Management from Niger Delta University. \nHe has taught classes at the Niger Delta University (department of community medicine), University of Maiduguri (department of geography), University of Uyo (center for wetlands and waste management studies) and Kwara State University (department of environmental health). Raimi Morufu Olalekan is the author or coauthor of more than 100 scientific publications and expert papers in American, European and Asian journal to his credit, 20 research projects under way including cumulative impact assessment of air quality and assessment of digital debris management in health Institutions in South-South, Nigeria. He has served as a key note speaker in many International and Local Conferences and has attended a number of certified educational seminars, participants of numerous symposiums in Nigeria and abroad. His H index is 20, i10 - index is 51, had 1164 Google citations, https://scholar.google.com/citations?user=nRBW82AAAAAJ&hl=en, SSRN citation 172, crossref citation 10 and download 2865, https://ssrn.com/author=2891311. San. Raimi Morufu Olalekan has successfully supervised more than (5) Master degrees candidates, two (2) doctorate degrees and currently supervising a number of Master and Doctorate degree candidates. His work on ground water pollution in the Niger Delta amongst others is opening new path of scientific knowledge and research in pollution control management and related fields. He is a reviewer and an editorial board member to many Scientific Journals viz: American Journal of Environmental Sciences, American Public Health Association (APHA), Plos One, Heliyon, Earth Science & Environment Research Journal (OMSP International), Science Publishing Group, CPQ Medicine, Acta Scientific Agriculture, MAR Microbiology, Journal of Environmental Science and Research, International Journal on Research Case Reports and Case Series, Journal of Education and Learning Management, African Journal of Humanities and Social Sciences,, Continental Journal of Applied Sciences, Continental Journal of Biological Sciences, Open Access Journal of Biomedical Engineering and Biosciences, Journal of Medical Care Research and Review, Journal of Nursing and Primary Care, Journal of Medical Reviews, New International Journal of Medicine and Science (NIJMS), Ecuadorian Journal of Science Research and Innovation, Academic Research Journal on Health Information Management, Journal of Research in Food Science and Nutrition, IMPACT: International Journal of Research in Humanities, Arts and Literature, American Journal of Epidemiology and Public Health, Pollution and Public Health, Advanced Journal of Toxicology: Current Research, International Journal of Case Reports & Short Reviews (IJCRSR), Journal of Research in Environmental Science and Toxicology, Journal of Community Medicine & Public Health Care, Journal of Bacteriology Research (JBR), Journal of Public Health and Epidemiology, Citizen Science: Theory and Practice, Agricultural Sciences Research Journal [ARJ], ES Journal of Public Health, American Journal of Environmental Protection, Elixir International Journal etc. and has also published several academic papers in academic International Journals, author of few books related to water pollution in the Niger Delta title: Assessment of Trace Elements in Surface and Ground Water Quality (Lambert academic publishing 2017, First edition) and member of a number learned societies. \nHis current research interests focus on pollution control management, water pollution and management, Environmental Impact Assessment, Waste management, institutional capacity building, policy and governance issues, environmental management, risk and vulnerability assessment, hazard mitigation, and resilience building. His taught courses include: Anthropogenic climate, Introduction to Environmental Health, Waste Management, Environmental Air Pollution and Human Health, Environmental Land Pollution and Human Health, Demography, Disaster Management, The Socio-Economic Environment, Biological and Physical Environment etc.",institutionString:"Saving One Million Lives Program for Results (SOML PforR) Bayelsa State Ministry of Health",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:{id:"452612",title:"Dr.",name:"Oyeyemi",middleName:"Abisoye",surname:"Sunday",slug:"oyeyemi-sunday",fullName:"Oyeyemi Sunday",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003N9ZMfQAN/Profile_Picture_1643704495237",biography:"Dr. Abisoye Oyeyemi is an Associate Professor at the Niger Delta University and a Consultant Public Health Physician at the Niger Delta University Teaching Hospital. He holds an MBBS degree (University of Ibadan), an MPH degree (University of Lagos), and is a Fellow of the National Postgraduate Medical College of Nigeria, Faculty of Public Health (FMCPH). He won the J.D. Soleye’s Prize for the best candidate in the 2010 Parts II FMCPH Examinations with the best dissertation and also won the Adetokunbo O. Lucas Prize for the best candidate in 2010 Part II FMCPH Examinations. \r\nHe has been in Medical practice for about 20 years, spending most of the time in public health and disease control. His academic and professional interests include infectious disease epidemiology, particularly malaria and HIV/AIDS; disease surveillance; and operations research. He served as Site Supervisor (rural site) for the first-ever PMTCT project in Bayelsa State – a partnership between Bayelsa State Government, UNICEF, and Nigerian Agip Oil Company, 2003-2005. He has participated in many research projects and intervention programs in disease control and has published on HIV/AIDS and malaria control among other topics.",institutionString:"Niger Delta University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Niger Delta University",institutionURL:null,country:{name:"Nigeria"}}},coeditorTwo:{id:"447559",title:"Dr.",name:"Henry Olawale",middleName:null,surname:"Sawyerr",slug:"henry-olawale-sawyerr",fullName:"Henry Olawale Sawyerr",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003JadeHQAR/Profile_Picture_1643702020798",biography:null,institutionString:"Kwara State University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Kwara State University",institutionURL:null,country:{name:"Nigeria"}}},coeditorThree:{id:"35151",title:"Prof.",name:"Teddy",middleName:"Charles",surname:"Adias",slug:"teddy-adias",fullName:"Teddy Adias",profilePictureURL:"https://mts.intechopen.com/storage/users/35151/images/system/35151.jpg",biography:"Dr. Teddy Charles Adias is currently the Vice-Chancellor of Federal University Otuoke, Nigeria, and the Provost of the Bayelsa State College of Health Technology, Ogbia-Town, Nigeria.\nHe holds a Ph.D. in Immuno-Haematology, and he is a Fellow of the Institute of Biomedical Science (FIBMS), London, UK. He has held several Adjunct academic appointments with various Nigerian universities and has taught at both postgraduate and undergraduate levels for over nine years. His current research interest is focused on Transfusion immunology, safety, alternatives, and hematology of infectious diseases. 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Epidemiologic evidence suggests that regular consumption of fruits and vegetables may reduce risk of some diseases, including cancer [1]. These properties have been attributed to foods that are rich sources of numerous bioactive compounds such as phytochemicals [2]. Modifying the intake of specific foods and/or their bioactive components seems to be a prudent, noninvasive, and cost-effective strategy for preventing some diseases in people who appear to be “healthy” [3]. As will be discussed in this chapter, potential problems occur when patients taking medicines regularly also consume certain fruits or vegetables.
Thousands of drugs are commercially available and a great percentage of the population takes at least one pharmacologically active agent on a regular basis. Given this magnitude of use and variability in individual nutritional status, dietary habits and food composition, there is a high potential for drug-nutrient interactions. However, there is a relatively short list of documented fruit-drug or vegetable-drug interactions, necessitating further and extensive clinical evaluation. Healthcare providers, such as physicians, pharmacists, nurses, and dietitians, have to be aware of important food-drug interactions in order to optimize the therapeutic efficacy of prescribed and over-the-counter drugs. Here, we review some of the most widely consumed fruits and vegetables to inform healthcare providers of possible nutrient-drug interactions and their potential clinical significance.
There are numerous patients who encounter increased risks of adverse events associated with drug-nutrient interactions. These include elderly patients, patients with cancer and/ or malnutrition, gastrointestinal tract dysfunctions, acquired immunodeficiency syndrome and chronic diseases that require the use of multiple drugs, as well as those receiving enteral nutrition or transplants. Therefore, the main reason for devoting a major review to nutrient-drug interactions is the enormous importance of fruits and vegetables used for their beneficial effects as nutrients and as components in folk medicine. There are currently few studies that combine a nutrient-based and detailed pharmacological approach [4], or studies that systematically explore the risk and benefits of fruit and vegetables [5-7].
A drug-nutrient interaction is defined as the result of a physical, chemical, physiological, or pathophysiological relationship between a drug and a nutrient [8,9]. An interaction is considered significant from a clinical perspective if it alters the therapeutic response. Food-drug interactions can result in two main clinical effects: the decreased bioavailability of a drug, which predisposes to treatment failure, or an increased bioavailability, which increases the risk of adverse events and may even precipitate toxicities (See Figure 1) [4, 10,11].
Drug-fruit/vegetable interaction and effects on bioavailability of drugs. During the consumption of drugs with fruits or vegetables the
Nutritional status and diet can affect drug action by altering metabolism and function. In addition, various dietary components can have pharmacological activity under certain circumstances [12]. For healthy-treatment intervention, it is necessary to understand how these drug-food interactions can induce a beneficial result or lead to detrimental therapeutic conditions (less therapeutic action or more toxicity). Drug-drug interactions are widely recognized and evaluated as part of the drug-approval process, whether pharmaceutical, pharmacokinetic, or pharmacodynamic in nature. Equal attention must be paid to food-drug interactions (Figure 2).
Bioassay models for studying drug-phytochemical interaction.
There are four types of accepted drug-food interactions based on their nature and mechanisms.
Type I are
Type II interactions affect absorption. They cause either an increase or decrease in the oral bioavailability of a drug. The precipitant agent may modify the function of enzymes or transport mechanisms that are responsible for biotransformation.
Type III interactions affect the systemic or physiologic disposition and occur after the drug or the nutritional element has been absorbed from the gastrointestinal tract and entered the systemic circulation. Changes in the cellular or tissue distribution, systemic transport, or penetration to specific organs or tissues can occur.
Type IV interactions refer to the elimination or clearance of drugs or nutrients, which may involve the antagonism, impairment or modulation of renal and/or enterohepatic elimination [13].
Drug metabolizing enzymes and drug transporters play important roles in modulating drug absorption, distribution, metabolism, and elimination. Acting alone or in concert with each other, they can affect the pharmacokinetics and pharmacodynamics of a drug. The interplay between drug metabolizing enzymes and transporters is one of the confounding factors that have been recently shown to contribute to potential complex drug interactions [14].
The oral administration of drugs to patients is convenient, practical, and preferred for many reasons. Oral administration of drugs, however, may lead to limited and variable oral bioavailability because of absorption across the intestinal barrier [15,16]. Drug absorption across the gastrointestinal tract is highly dependent on affinity for membrane transporters as well as lipophilicity [17]. On the other hand, the liver plays a key role in the clearance and excretion of many drugs. Hepatic transporters are membrane proteins that primarily facilitate nutrient and endogenous substrate transport into the cell via uptake transporters, or protect the cell by pumping out toxic chemicals via canalicular transporters [18]. Consequently, drug transporters in both the gut and the liver are important in determining oral drug disposition by controlling absorption and bioavailability [19]
The major uptake transporters responsible for nutrient and xenobiotic transport, both uptake and efflux transporters, belong to the two solute carrier (SLC and SLCO) superfamilies [20]. The SLC superfamily encompasses a variety of transporters, including the organic anion transporters (OAT, SLC22A), the organic cation transporters (OCT, SLC22A), the electroneutral organic cation transporters (OCTN, SLC22A), the equilibrative nucleoside transporters (ENT, SLC29), the concentrative nucleoside transporters (CNT, SLC28), the apical Na+−dependent bile salt transporter (ASBT, SLC10), the monocarboxylate transporters (MCT, SLC16), and the peptide transporters (PEPT, SLC15) [21]. The SLCO family is made up of the organic anion transporting polypeptides (OATP) [22]. Efflux transporters expressed in the intestine and liver include P-glycoprotein (Pgp, ABCB1), bile salt export pump (BSEP, ABCB11), multidrug resistance proteins (MRP1- 6, ABCC1-6), and breast cancer resistance protein (BCRP, ABCG2), all members of the ATP-Binding Cassette superfamily (ABC transporters) [23]. Members of this superfamily use ATP as an energy source, allowing them to pump substrates against a concentration gradient. In the liver, uptake transporters are mainly expressed in the sinusoid, and excretion transporters are mainly expressed on the lateral and canalicular membranes. There are transporters on the lateral membrane the primary function of which is pumping drugs back into the blood circulation from the hepatocytes. Nowadays, a large amount of work has identified and characterized intestinal and hepatic transporters in regards to tissue expression profiles, regulation, mechanisms of transport, substrate and inhibitor profiles, species differences, and genetic polymorphisms. Given the circumstances outlined above, there is no doubt of the overall relevance of drug transport for clinical pharmacokinetics.
Until recently, little regard was given to the possibility that food and food components could cause significant changes to the extent of drug absorption via effects on intestinal and liver transporters. It is now well known that drug-food interactions might affect the pharmacokinetics of prescribed drugs when co-administered with food [24]. Common foods, such as fruits and vegetables, contain a large variety of secondary metabolites known as phytochemicals (Tabla 1), many of which have been associated with health benefits [25]. However, we know little about the processes through which these phytochemicals (and/or their metabolites) are absorbed into the body, reach their biological target, and are eliminated. Recent studies show that some of these phytochemicals are substrates and modulators of specific members of the superfamily of ABC transporting proteins [26]. Indeed,
It has been shown that, before reaching the systemic circulation, the metabolism of orally ingested drugs (‘first-pass metabolism’ or ‘presystemic clearance’) has clinically relevant influences on the potency and efficacy of drugs. Both the intestine and liver account for the presystemic metabolism in humans. Drug metabolism reactions are generally grouped into 2 phases. Phase I reactions involve changes such as oxidation, reduction, and hydrolysis and are primarily mediated by the cytochrome P450 (CYP) family of enzymes. Phase II reactions use an endogenous compound such as glucuronic acid, glutathione, or sulfate, to conjugate with the drug or its phase I–derived metabolite to produce a more polar end product that can be more readily excreted [33].
The CYP enzymes involved in drug metabolism in humans are expressed predominantly in the liver. However, they are also present in the large and small intestine, lungs and brain [34]. CYP proteins are categorized into families and subfamilies and can metabolize almost any organic xenobiotic [35]. CYP enzymes combined with drug transport proteins constitute the first-pass effect of orally administered drugs [33]. On the other hand, the Phase II drug metabolizing or conjugating enzymes consist of many enzyme superfamilies, including sulfotransferases (SULT), UDP-glucuronosyltransferases (UGT), DT-diaphorase or NAD(P)H:quinone oxidoreductase (NQO) or NAD(P)H: menadione reductase (NMO), epoxide hydrolases (EPH), glutathione S-transferases (GST) and
The metabolism of a drug can be altered by foreign chemicals and such interactions can often be clinically significant [37]. The most common form of drug interactions entail a foreign chemical acting either as an inhibitor or an inducer of the CYP enzyme isoform responsible for metabolizing an administered medicinal drug, subsequently leading to an unusually slow or fast clearance of said drug [38,39]. Inhibition of drug metabolism will result in a concentration elevation in tissues, leading to various adverse reactions, particularly for drugs with a low therapeutic index.
Often, influence on drug metabolism by compounds that occur in the environment, most remarkably foodstuffs, is bypassed. Dietary changes can alter the expression and activity of hepatic drug metabolizing enzymes. Although this can lead to alterations in the systemic elimination kinetics of drugs metabolized by these enzymes, the magnitude of the change is generally small [8, 40]. Metabolic food-drug interactions occur when a certain food alters the activity of a drug-metabolizing enzyme, leading to a modulation of the pharmacokinetics of drugs metabolized by the enzyme [12]. Foods, such as fruits, vegetables, alcoholic beverages, teas, and herbs, which consist of complex chemical mixtures, can inhibit or induce the activity of drug-metabolizing enzymes [41].
The observed induction and inhibition of CYP enzymes by natural products in the presence of a prescribed drug has (among other reasons) led to the general acceptance that natural therapies can have adverse effects, contrary to popular beliefs in countries with active ethnomedicinal practices. Herbal medicines such as St. John\'s wort, garlic, piperine, ginseng, and gingko, which are freely available over the counter, have given rise to serious clinical interactions when co-administered with prescription medicines [42]. Such adversities have spurred various pre-clinical and
Fruits and vegetables are known to be important components in a healthy diet, since they have low energy density and are sources of micronutrients, fiber, and other components with functional properties, called phytochemicals (See Figure 2). Increased fruit and vegetable consumption can also help displace food high in saturated fats, sugar or salt. Low fruit and vegetable intake is among the top 10 risk factors contributing to mortality. According to the World Health Organization (WHO), increased daily fruit and vegetable intake could help prevent major chronic non-communicable diseases [44]. Evidence is emerging that specific combinations of phytochemicals may be far more effective in protecting against some diseases than isolated compounds (Table 1 and 2). Observed drug-phytochemical interactions, in addition to interactions among dietary micronutrients, indicate possibilities for improved therapeutic strategies. However, several reports have examined the effects of plant foods and herbal medicines on drug bioavailability. As shown in Tables 3 and 4 and as discussed below, we have surveyed the literature to identify reports suggesting important food and phytochemical modulation of drug-metabolizing enzymes and drug transporters leading to potential important nutrient-drug interactions.
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Fruit-Drug Interactions
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Vegetable-Drug Intractions
The interaction of grapefruit with certain drugs was unintentionally discovered two decades ago [45]. Since then, there have been numerous reports on the effects of grapefruit and its components on CYP450 drug oxidation and transportation [46,47]. Several findings showed that grapefruit juice had a major effect on the intestinal CYP system with a minor effect at the hepatic level [48]. The predominant mechanism for this interaction is the inhibition of cytochrome
The interaction between grapefruit juice and drugs has been potentially ascribed to a number of constituents [27]. It has been suggested that flavonoids such as naringin, naringenin, quercetin, and kaempferol, major components in grapefruit, are responsible for drug interaction. Some of these chemicals are also found in other fruit juices. Pomegranate, for example, shares certain properties with grapefruit, suggesting that both could modify the bioavailability of drugs [55,56]. Another group of compounds that has been detected in grapefruit juice are the furanocoumarins (psoralens), which are known to be mechanism-based inactivators of CYP450. The major furanocoumarin present in grapefruit is bergamottin, which demonstrated a time- and concentration-dependent inactivation of CYP enzymes
This inhibitory interaction should be kept in mind when prescribing drugs metabolized by CYP3A4. Examples of drugs affected by grapefruit or its components include: calcium channel antagonists such as felodipine, nisoldipine, amlodipines, verapamil, and diltiazem [57]; central nervous system modulators, including diazepam, triazolam, midazolam, alprazolam, carbamazepine, buspurone and sertraline [58]; HMG-CoA reductase inhibitors, such as simvastatin, lovastatin, atorvastatin, and pravastatin [59]; immunosuppressants such as cyclosporine [60]; anti-virals such as saquinavir [61]; a phosphodiesterases-5 inhibitor such as sildenafil [62]; antihistamines, including as terfenadine and fexofenadine [63]; antiarhythmics such as amiodarone [62]; and antibiotics such as eritromicine [64].
Epidemiologic studies reveal that approximately 2% of the population in the United States consumes at least one glass of regular strength grapefruit juice per day. This becomes pertinent if we consider that many people suffer from chronic metabolic diseases (including hypertension, hyperlipidemia, and cardiovascular diseases) and receive calcium channel antagonis therapy and HMG-CoA reductase inhibitors. Patients with mental disorders also chronically receive central nervous system modulators. In the case of many drugs, an increase in serum drug concentration has been associated with increased frequency of dose-dependent adverse effects [65-67]. In light of the wide ranging effects of grapefruit juice on the pharmacokinetics of various drugs, physicians need to be aware of these interactions and should make an attempt to warn and educate patients regarding the potential consequences of concomitant ingestion of these agents.
Consumption of most types of orange juice does not appear to alter CYP3A4 activity
It has also been observed that components of orange juice -naringin in particular- are
Previous studies in humans using fexofenadine as a probe showed that oral coadministration with orange juice decreased the oral bioavailability of fexofenadine [63]. Orange juice and its constituents were shown to interact with members of the OATP transporter family by reducing their activities. The functional consequences of such an interaction are reflected in a significant reduction in the oral bioavailability of fexofenadine, possibly by preferential direct inhibition of intestinal OATP activity. Other reports indicate that orange juice slightly reduced the absorption of ciprofloxacin, levofloxacin and celiprolol [65] A study of an interaction between orange juice and pravastatin showed an increase in AUC [54].Orange juice also moderately reduces the bioavailability of atenolol, which may necessitate a dose adjustment [71,72].
Early studies demonstrated the influence of tangeretin, a flavonoid found in high levels in tangerine juice, on drug metabolizing liver enzymes. It was demonstrated that tangeretin inhibits P450 1A2 and P450 3A4 activity in human liver microsomes [73]. Tangeretin is a potent regioselective stimulator of midazolam 1\'-hydroxylation by human liver microsomes CYP3A4. Although, clinical studies have shown no influence on midazolam pharmacokinetics
Grapes are one of the most valued conventional fruits worldwide. The grape is considered a source of unique and potentially useful medicinal natural products; they are also used in the manufacturing of various industrial products [75,76](Yadav and others 2009; Vislocky and Fernandez 2010). The main biologically active and well-characterized constituent from the grape is resveratrol, which is known for various medicinal properties in treating human diseases [75](Yadav and others 2009). Resveratrol was shown to be an irreversible (mechanism-based) inhibitor of CYP3A4 and a non-competitive reversible inhibitor for CYP2E1 in microsomes from rat liver and human liver cells containing cDNA-expressed CYPs [77,78](Chan and Delucchi 2000; Piver and others 2001). Resveratrol is an electron-rich molecule with two aromatic benzene rings linked by an ethylene bridge. CYP3A-mediated aromatic hydroxylation and epoxidation of resveratrol are possible, resulting in a reactive p-benzoquinone methide metabolite which is capable of binding covalently to CYP3A4, leading to inactivation and potential drug interactions.
American cranberry is a fruit used as a prophylactic agent against urinary tract infections [79]. Drug interactions with cranberry juice might be related to the fact that the juice is rich in flavonol glycosides, anthocyanins, proanthocyanidins, and organic and phenolic acids [80]. Izzo [81] described a total of eight cases of interaction between cranberry juice and warfarin, leading to changes in international normalized ratio (INR) values and bleeding. The mechanism behind this interaction might be the inhibition by cranberry flavonoids of CYP3A4 and/or CYP2C9 enzymes, which are responsible for warfarin metabolism [31,82].
It has also been shown that cranberry juice inhibits diclofenac metabolism in human liver microsomes, but this has not been demonstrated clinically in human subjects [83]. Cranberry juice may increase the bioavailability of CYP3A4 substrates (e.g., calcium antagonists or calcineurin inhibitors) as was discussed [61]. Uesawa and Mohri have demonstrated that nifedipine metabolism in rat intestinal and human hepatic microsomes are inhibited by preincubation with cranberry juice. Furthermore, cranberry juice increased the nifedipine concentration in rat plasma. These findings suggest that cranberry juice might affect the plasma concentration of nifedipine in humans as well [84].
Pomegranate is commonly eaten around the world and has been used in folk medicine for a wide variety of therapeutic purposes [85-86]. Pomegranate is a rich source of several chemicals such as pectin, tannins, flavonoids, and anthocyanins. It has been have reported that pomegranate juice influenced the pharmacokinetics of carbamazepine in rats by inhibiting enteric CYP3A activity. Such inhibition of the enteric CYP3A activity by a single exposure to pomegranate juice appears to last for approximately 3 days [56]. Nagata and others [88] found that pomegranate juice inhibited human CYP2C9 activity and increased tolbutamide bioavailability in rats. Recently, pomegranate juice was shown to potently inhibit the sulfoconjugation of 1-naphthol in Caco-2 cells. It has been suggested that some constituents of pomegranate juice, most probably punicalagin, may impair the metabolic functions of the intestine (specifically sulfoconjugation) and therefore might have effects upon the bioavailability of drugs [89].
The beneficial effects of mango include anti-inflammatory and antimicrobial activities [90,91] Preliminary phytochemical screening revealed the presence of flavonoids, including quercetin and glycosylated xanthones such as mangiferin [92,93] Quercetin has been shown to possess antioxidant, antimicrobial, antitumor, antihypertensive, antiatherosclerosis, and anti-inflammatory properties [94]. In a series of studies, Rodeiro and others have shown the effects of mango on drug metabolizing enzymes and drug transporters [95, 96] They found that exposure of hepatocytes to mango extract produced a significant reduction (60%) in 7-methoxyresorufin-O-demethylase (MROD; CYP1A2) activity and an increase (50%) in 7-penthoxyresorufin-O-depentylase (PROD; CYP2B1) activity. This group also studied the effect of mangiferin on CYP enzymes and found that mangiferin reduced the activities of five P450s: POD (CYP1A2), midazolam 1\'-hydroxylation (M1OH; CYP3A1), diclofenac 4\'-hydroxylation (D4OH; CYP2C6), S-mephenytoin 4\'-hydroxylation (SM4OH), and chlorzoxazone 6-hydroxyaltion (C6OH; CYP2E1). Recently, mango and mango-derived polyphenols have been shown to potentially affect the activity of the multidrug transporter P-gp ABCB1 [97]. These findings suggest that mango and its components inhibit the major human P450 enzymes involved in drug metabolism and some transporters. The potential for drug interactions with mango fruit should therefore be considered.
Guava is an important food crop and medicinal plant in tropical and subtropical countries; it is widely used as food and in folk medicine around the world [98, 99]. A number of metabolites such as phenolics, flavonoid, carotenoid, terpenoid and triterpene have been found in this fruit. Extracts and metabolites of this plant, particularly those from the leaves and fruit, possess useful pharmacological activities [100]. There is only one report about the effect of guava extracts on drug transport: guava extract showed a potent inhibitory effect on P-gp mediated efflux in Caco-2 cells. It was also found to inhibit efflux transport from serosal to mucosal surfaces in the rat ileum [101]. This means that guava could interact with P-gp substrates such as digoxin, fexofenadine, indinavir, vincristine, colchicine, topotecan, and paclitaxel in the small intestine. For this reason, this fruit should be consumed with caution by patients taking medicines.
Berries have been shown to have a positive impact on several chronic conditions including obesity, cancer, and cardiovascular and neurodegenerative diseases [102-104]. Like other fruits, raspberries contain micro- and macronutrients such as vitamins, minerals, and fiber. Their biological properties, however, have been largely attributed to high levels of various phenolic compounds, as well as the interactive synergies among their natural phytochemical components (e.g., ellagic acid, quercetin, gallic acid, anthocyanins, cyanidins, pelargonidins, catechins, kaempferol and salicylic acid). Raspberry or raspberry constituents have antioxidant and anti-inflammatory properties, and inhibit cancer cell growth [105-107]. Black raspberries (
Apple and its products contain high amounts of polyphenols, which show diverse biological activities and may contribute to beneficial health effects such as protecting the intestine against inflammation due to chronic inflammatory bowel diseases [108, 109]. It has been found that apple juice extract inhibits CYP1A1 at levels of CYP1A1 mRNA, protein, and enzymatic activity [110]. On the other hand, it has also been reported that apple juice and its constituents can interact with members of the OATP transporter family (OATP-1, OATP-3 and NTCP) by reducing their activities
Papaya is prized worldwide for its flavor and nutritional properties. An ethno-botanical survey showed that papaya is commonly used in traditional medicine for the treatment of various human diseases, including abdominal discomfort, pain, malaria, diabetes, obesity, infections, and oral drug poisoning [111,112]. Papaya leaves and seeds are known to contain proteolytic enzymes (papain, chymopapain), alkaloids (carpain, carpasemine), sulfurous compounds (benzyl iso- thiocyanate), flavonoids, tannins, triterpenes, anthocyanins, organic acids and oils. Papaya fruit is a good source of nutrients and some phytochemicals such as beta-cryptoxanthin and benzyl isothiocyanates [113]. Hidaka et al. found that
Broccoli (
Watercress is another important member of the cruciferous vegetables, an excellent source for glucosinolates and other bioactive phytochemicals [124]. Watercress (
Spinach (
Tomatoes (
Carrots (
Avocado (
Red pepper (
Yeh and Yen have reported that asparagus, cauliflower, celery and eggplant induced significant phenol sulfotransferase –P (PST-P) activity, whereas asparagus, eggplant and potato induced PST-M activity [123]. It has been have also reported that a diet supplemented with apiaceous vegetables (dill weed, celery, parsley, parsnip) resulted in a 13-15% decrease in CYP1A2 activity [122]. The authors speculate that furanocumarins present in the apiaceous vegetables were responsible for the inhibitory effects on CYP1A2 ^115 [117,160].
Vegetables such as cabbage, celery, onion and parsley are known to have a high content of polyphenols. It has been reported that polyphenols can potentially affect phase I metabolism either by direct inhibition of phase I enzymes or by regulating the expression of enzyme levels
Weight-reduction diets, vegetarian diets, hospitalization, or post-operative regimes all lead to dietary modifications. These diets are often maintained for long periods of time and are likely to result in metabolic changes due to subsequently administered drugs or exposure to environmental chemicals. Several epidemiologic, clinical, and experimental studies have established that certain types of diet may have beneficial effects on health. For example, the traditional Mediterranean diet has been shown to reduce overall mortality and coronary heart disease events [162]. This diet, however, varies across at least 16 countries bordering the Mediterranean Sea. Cultural, ethnic, religious, economic and agricultural differences in these regions account for variations in dietary patterns, which are widely characterized by the following: daily consumption of fruits, vegetables, whole grain breads, non-refined cereals, olive oil, and dairy products; moderate weekly consumption of fish, poultry, nuts, potatoes, and eggs; low monthly consumption of red meat, and daily moderate wine consumption [163]. Increasing evidence suggests that a Mediterranean-style diet rich in fruits, vegetables, nuts, fish and oils with monounsaturated fat and low in meat promotes cardiovascular health and aids cancer prevention because of its positive effects on lipid profile, endothelial function, vascular inflammation, insulin resistance, and its antioxidant properties [164,165].
Vegetarians, on the other hand, exhibit a wide diversity of dietary practices often described by what is omitted from their diet. When a vegetarian diet is appropriately planned and includes fortified foods, it can be nutritionally suitable for adults and children and can promote health and lower the risk of major chronic diseases [166]. A vegetarian diet usually provides a low intake of saturated fat and cholesterol and a high intake of dietary fiber and many health-promoting phytochemicals. This is achieved by an increased consumption of fruits, vegetables, whole-grains, legumes, nuts, and various soy products. As a result of these factors, vegetarians typically have a lower body mass index, low-density lipoprotein cholesterol levels, and lower blood pressure; a reduced ischemic heart disease death rate; and decreased incidence of hypertension, stroke, type 2 diabetes, and certain cancers that are more common among non-vegetarians [167]. The vegan dietary category may be more comparable across countries and cultures because avoiding all animal products leaves little choice but to include large quantities of vegetables, fruit, nuts, and grains for nutritional adequacy. Admittedly, vegetable and fruit variety may also vary widely according to location [168].
Due to their high content of fruits and vegetables, all these diets contain a large proportion of antioxidant vitamins, flavonoids, and polyphenols [169]. Phenolic compounds may help protect the gastrointestinal tract against damage by reactive species present in foods or generated within the stomach and intestines. However, they may be beneficial in the gut in correct amounts. The overall health benefits of polyphenols are uncertain, and consumption of large quantities of them in fortified foods or supplements should not yet be encouraged [170].
Flavonoids have been known as plant pigments for over a century and belong to a vast group of phenolic compounds that are widely distributed in all foods of plant origin. Unfortunately, the potentially toxic effects of excessive flavonoid intake are largely ignored. At higher doses, flavonoids may act as mutagens, pro-oxidants that generate free radicals, and as inhibitors of key enzymes involved in hormone metabolism [171]. It has been shown that phenol ring-containing flavonoids yield cytotoxic phenoxyl radicals upon oxidation by peroxidases; co-oxidize unsaturated lipids, GSH, NADH, ascorbate, and nucleic acids; and cause ROS formation and mitochondrial toxicity [172]. In high doses, the adverse effects of flavonoids may outweigh their beneficial ones, and caution should be exercised when ingesting them at levels above those which would be obtained from a typical vegetarian diet [173]. Moreover, it is possible that people ingesting a vegetarian or Mediterranean diet may be taking medication and thus have drug-food interaction.
Inhibition of CYP enzymes, which are necessary for carcinogen activation, is a beneficial chemopreventive property of various flavonoids but may be a potential toxic property in flavonoid-drug interactions. Inhibition of CYP activities by flavonoids has been extensively studied because of their potential use as blocking agents during the initial stage of carcinogenesis [174]. The general conclusion after an analysis of available data on CYP-flavonoid interactions is that flavonoids possessing hydroxyl groups inhibit CYP activity, whereas those lacking hydroxyl groups may induce the metabolizing enzyme [175]. Flavonoids can either inhibit or induce human CYP enzymes depending on their structure, concentration, or experimental conditions [176]. The interaction of flavonoids with CYP3A4, the predominant human hepatic and intestinal CYP responsible for metabolizing 50% of therapeutic agents as well as the activation of some carcinogens, is of particular interest [177].
The simultaneous administration of flavonoids present in fruits or vegetables and clinically used drugs may cause flavonoid-drug interactions by modulating the pharmacokinetics of certain drugs, which results in an increase in their toxicity or a decline in their therapeutic effect, depending on the flavonoid structure [178]. Additional reasons for concern regarding mega flavonoid supplements include potential flavonoid-drug interactions, since flavonoids have been shown to both induce and inhibit drug-metabolizing enzymes [38, 39]. Further research regarding the potential toxicities associated with flavonoids and other dietary phenolics is required if these plant-derived products are to be used as therapy.
It is a fact that diets based on fruits and vegetables may have a variety of phytochemicals, as was mentioned earlier, so the possibility of developing a drug-food interaction is high. While dietary polyphenols may be beneficial in the correct amount, but too much may not be good and combining them with medication should be avoided.
WHO and the Food and Agriculture Organization of the United Nations (FAO) recommend a daily intake of at least 400 grams or five servings of fruits and vegetables to aid in the prevention of chronic illnesses such as heart disease, cancer, diabetes, and obesity. As a consequence, there is an increased global consumer demand for fruits and vegetables, and some consumers purchase organic foods with the understanding that they are healthy. The use of natural products for improving human health has evolved independently in different regions of the world and production, use, attitudes, and regulatory aspects vary globally. Although modern medicine may be available in most countries for the treatment of many chronic degenerative diseases, folk medicine (phytomedicine) has remained popular for historical and cultural reasons. Although the significance of interactions between drugs is widely appreciated, little attention has been given to interactions between drugs and nutrients. Most of the documented information about the effects of fruit and vegetables on metabolizing enzymes and drug transporters comes from preclinical studies. However, the possibility that these effects could occur in humans should not be ignored. Several clinical studies on the interactions of grapefruit juice and drugs have been conducted with impressive results. Most of the fruits and vegetables examined in this review contain a similar phytochemical mix to that of grapefruit juice.
The community prevalence of ADHD worldwide has been estimated at being between 3% and 7% [1, 2]. Yet, the rate of administrative prevalence (number of individuals with a clinical diagnosis) in the UK is approximately 1% [3] and varies between 0.3% and 2.5% across the globe [4], demonstrating a wide difference from the estimated community prevalence. While it is difficult to assess the exact administrative prevalence across the world, these figures imply that ADHD is underdiagnosed and under-treated in many countries [4, 5]. For instance, in the UK, reports suggest that only 0.73% of children and 0.06% of adults currently receive ADHD medication [6]. Even when patients have received a diagnosis, medication use varies widely across European countries [7] and treatment is often low. A greater understanding of the reasons behind these discrepancies is required [8].
The access to care pathway varies widely across countries. For example, in the US, ADHD is generally managed by private PCPs. However, in countries including much of Africa, Asia, Central and South America and parts of southern Europe, ADHD rates of recognition remain low, and resources available for treatment tend to be mainly focused on tertiary centres rather than in primary care settings [9]. In the UK, diagnosis and treatment are managed in secondary care services following a referral from PCPs. While this chapter discusses the generic role and understanding of PCPs in ADHD care, the focus is primarily on care pathways similar to the one in the UK.
Different factors have been identified concerning the difficulties in accessing care, for example, parents’ lack of recognition and lack of help-seeking [10], the complexity of the ADHD care pathway or primary care physicians’1 lack of recognition [8, 12].
Although many factors influence service utilisation, the first port of call tends to be PCPs who act as gatekeepers in many countries. To receive an ADHD assessment and diagnosis, patients are often referred to specialist healthcare services (psychiatrists, paediatricians, etc.) through their PCPs [13]. Once a diagnosis has been made, PCPs can be involved in supporting the management of children with ADHD and in liaising with parents and specialists. It is, therefore, primordial that PCPs have a comprehensive understanding of ADHD.
To further understand PCPs’ awareness of ADHD, a few systematic reviews [8, 14, 15] have summarised the factors influencing their understanding. The main findings from these studies highlighted lack of knowledge, recognition and training as critical barriers to PCPs’ understanding of ADHD. Misconceptions about ADHD in primary care were also observed as well as other barriers, such as the complexity of the multidisciplinary approach of the pathway to care and the lack of services, were also identified by more recent studies [12, 16]. However, the main recurring theme from these reviews and research was the lack of training on ADHD and the need for tailored training programs for PCPs.
Informed by this evidence, an online intervention aimed to increase PCPs’ awareness and knowledge was developed. This online psycho-education intervention was co-produced with PCPs to address the gaps in ADHD knowledge and training, reduce misconceptions and clarify the role of the PCPs within the ADHD pathway to care. The development process involved multiple steps, including developing an online resource, producing patients’ testimony videos and experts’ videos, collating and editing relevant information and a thorough review process. The evaluation of this intervention demonstrated that this online resource significantly improved PCPs’ knowledge and attitudes towards ADHD, reduced their misconceptions and impacted their practice. It also highlighted that the intervention was acceptable and feasible in both controlled and real-life settings. Finally, the important contribution and the implication of these findings are discussed. Considerations over the development process, the impact on primary care and implications for future research and clinical settings are also presented.
The pathway to care for ADHD is complex and varies widely across countries [4]. In the UK for instance, care pathways challenges are often generated by the wide variation of service provisions across different areas. Healthcare services are different from one locality to another, and commissioning decisions vary across the country.
Many guidelines on ADHD have been developed to standardise ADHD care. European guidelines were developed to further ADHD understanding and standard care across Europe [17], guiding healthcare professionals on acceptable healthcare standards and clarifying the different steps in ADHD care from identification to treatment. These steps are described as recognition, identification and referral, diagnosis and management. However, the timeframe and specificities of processes within these different steps are ambiguous.
While published guidelines aim to inform and influence the different steps in accessing care for ADHD, little is known about how well they are implemented into local clinical practice. The main difficulty with published guidelines is understanding the complex implementation in day-to-day practice. For instance, the referral and diagnosis process in European countries such as the UK involves referral to services that may or may not be available in different regions [18, 19], for example for adult services. A European review [20] confirmed a lack of adult services across Europe and highlighted the limited experience and knowledge of healthcare professionals on adult ADHD, posing an issue on who is then responsible for treatment management.
Issues with services and care pathways directly impact the referral or diagnostic process. For instance, it creates longer waiting times to receive access to care [21]. In this European review, Fridman and colleagues established that the UK had the longest waiting times, with the meantime from the first PCP visit to receiving a diagnosis of 18.3 months [21]. They also highlighted that a majority of caregivers (35%) experienced substantial difficulties in obtaining an ADHD diagnosis, lack of sufficient resources and gaps in support from healthcare providers being significant challenges in accessing care. Additionally, Kovshoff and colleagues [22] found that clinicians perceived the assessment and diagnosis decision-making processes to be inherently complex, requiring a great deal of time and experience.
The care pathway for ADHD is very complex and very few countries have clear diagnosis and treatment pathways. While guidelines aim to improve access to care by facilitating healthcare professionals’ decision-making, many barriers impact their application into practice. These barriers reflect the complexity of a multiple-level approach, significantly affecting the quality of care for adults and children with ADHD and practice by healthcare professionals.
While healthcare professionals’ roles in the ADHD pathway vary across countries and regions, in the majority of cases, PCPs act as gatekeepers. After initial identification, PCPs will refer patients to specialist services, where individuals can gain an assessment, diagnosis and access to treatment if required. PCPs are also at times responsible for handling prescriptions of medication once treatment has been initiated. In most countries, PCPs are not responsible for diagnosing ADHD and initializing treatment.
Many complexities arise from PCPs being able to correctly refer to and identify ADHD. First and foremost, PCPs are under intense pressure with unprecedented workloads [23, 24] and only have a short scheduled time to see their patients. The identification process is complex and includes evaluating the patient’s behaviour in different settings and over a period of time, it often requires multiple appointments. It is, therefore, a demanding process that cannot be routinely conducted during a standard ten-minute consultation.
Secondly, discrimination (such as sex and gender) can sometimes happen in the identification of ADHD in primary care [25, 26], especially for adults. Adults presenting to their PCPs might have developed other complex issues (such as depression or anxiety) due to untreated ADHD in childhood, making it very difficult for PCPs to unpick [27] and adult ADHD can also be somewhat controversial with stigmas still strongly present [28] and beliefs over the continuation of the disorder into adulthood mixed [29, 30]. Similarly, gender bias is strongly prominent, and girls tend to be identified less than boys [25, 31]. However, girls tend to show more inattentive traits than boys, who tend to show more hyperactivity traits [32], which makes it more complex to identify in a brief PCP consultation.
Finally, other barriers at these early stages have been identified. Sayal, Goodman and Ford [10] for instance highlighted that one of these barriers was the limited presentation of these problems to primary care. PCPs may hold negative feelings towards ADHD and see the ADHD label as a negative diagnostic label [8, 14] and many PCPs report low levels of confidence in the recognition and management of ADHD [33]. Moreover, Hinshaw and colleagues [9] highlighted significant cultural and historical differences between countries in the belief of ADHD as a valid disorder, demonstrating a substantial variance in attitudes and knowledge.
PCPs hold a gatekeeping role in accessing ADHD care, and their understanding and awareness of the disorder are of utmost importance in facilitating patients’ access to a diagnosis and treatment. Unmanaged and untreated ADHD results in long-term impairments in many domains [34]. In adulthood, these issues are associated with higher criminal behaviour rates, loss of work, addiction, suicidality and failed relationships [35] demonstrating that untreated ADHD can have substantial economic and social burdens [36]. There is, therefore, a strong need for early detection and diagnosis and gaining timely access to care is of great importance.
Previous studies have highlighted that many barriers to recognition exist in primary care settings (such as misconceptions, lack of education, or lack of resources), preventing access to care for individuals with ADHD and potentially impacting diagnosis rates. Three recent systematic reviews have summarised the current evidence based on primary care knowledge and pathways [8, 14, 15] and the key themes were identified as a strong need for education and training, presence of misconceptions and stigma, time and resource constraints with recognition and management and treatment [14]. Many misconceptions were expressed including disbeliefs regarding the validity of ADHD as a disorder as well as strong misconceptions about medications and the role of the parents [15]. Wider determinants, continuity of care and identification of needs also contributed to the complexity of understanding ADHD in primary care settings [8]. These findings suggest many interacting factors are at play in the recognition of ADHD by primary care practitioners with a strong recurring theme of a significant need for better education on ADHD.
Previous research has demonstrated that accessing care can be influenced by the knowledge and attitudes of health professionals [37], with limited PCPs recognition being a key barrier [8, 14]. In many countries, very few PCPs have received formal training on ADHD [14, 15] with lack of education about the disorder being a key component of their lack of confidence [33]. Primary care professionals also often feel inadequately equipped to manage or recognise adult ADHD [38]. Interviews with PCPs and other stakeholders [12] described the ADHD pathway and the role of primary care as an intricate process. Many factors impacted this process, such as lack of services, limited PCPs’ recognition and knowledge, and challenging communication between multiple stakeholders. Therefore limited recognition in primary care could be due to the lack of accurate knowledge and understanding of the disorder, scepticism, misconceptions and many stigmas still associated with ADHD [8, 14, 15]. Interventions to improve access [8] and training for PCPs [12] have been highlighted as a strong need and present a potential solution to the lack of ADHD knowledge in primary care settings.
Establishing the right training program is important for busy professionals such as PCPs. While an ideal training program does not exist key elements have been identified to promote successful learning, namely, accessibility and co-production. Their use of online training has significantly increased over the last two decades [39, 40], with a US study reporting an increase of physicians taking part in online learning activities from 605,410 to 4,365,014 between 2002 and 2008 alone [39]. Online training offers many advantages for PCPs such as being easily accessible anywhere and at times that work around their busy schedules. Online training has been shown to improve PCPs’ practice as well as knowledge [41]. However, to promote uptake of these training programs, they must meet PCPs’ needs and are deemed feasible and acceptable. Interventions tailored to address identified barriers have been shown to improve professional practise [42]. Co-produced research offers the opportunity to enhance this. Embedding co-production activities into research and training development is a way to promote responsible innovation and to ensure that the research outputs are relevant, engaging and desirable for the end-users [43, 44].
Previous studies have established key barriers and themes in understanding ADHD in primary care. In order to address issues around knowledge and confidence of PCPs, an online intervention was developed, informed by these findings. Focusing on increasing knowledge and reducing misconceptions about ADHD, an online psycho-educational intervention was developed over nine months. At first, a concrete plan for the development of the intervention was put in place to improve PCPs’ knowledge of ADHD and optimise appropriate referrals. This training was co-developed with PCPs as involving end-users enhances their clinical utility and impacts routine clinical practice.
The process followed a step-wise, co-production approach [45]. The three steps process was informed by previous studies [8, 14, 15] highlighting the relevant topics to be included in the intervention. Educational videos and online materials were developed, and workshops and reviews were then conducted with PCPs, leading to further refinement of the content and, subsequently, the final intervention.
The first step in the development process was to aggregate evidence-based knowledge on PCPs’ understanding of ADHD to gain a more specific idea of the gaps to be addressed. Careful considerations of the barriers highlighted by the systematic reviews [8, 14, 15] and the issues highlighted by other recent studies needed to be given [12, 16, 46]. As many barriers were established, deciding which barriers could be addressed in the intervention and which were beyond the realm of the project was essential. For instance, the barrier of lack of knowledge could be easily addressed through the training but barriers such as lack of resources or issues with services could not be addressed.
The second step in the development process involved filming a video of children with ADHD talking about their experiences. An adult video had previously been produced by a local adult ADHD clinic (Video1https://vimeo.com/64790626). This compelling video highlighted the importance of including patients’ experiences of ADHD to convey a greater understanding of the impact it has in everyday life. Permission to use this video within the remit of this thesis was granted, and it was decided to create a similar one with children (Video2 https://vimeo.com/306201810). The same filming company was used to ensure coherence between the two videos and these two short videos were included in the intervention.
The next step in the intervention development process was to create the online resource. For this, and after researching different options, a team specialising in health e-learning resources (HELM) was selected. A specific development programme was followed according to their own tested methods, which involved key researchers developing the content of the intervention and HELM creating the learning platform. This last step involved different steps. Firstly, workshops were conducted with PCPs to develop a tailored resource that will meet their needs. Suggestions from PCPs were then integrated and implemented into the intervention, to the best of the researchers’ abilities. For instance, PCPs suggested including videos of clinical and academic experts as well as the patients’ videos. Four new videos reflecting different expertise were subsequently added. Secondly, a review process from expert academics and PCPs insured that the final product developed was appropriately targeted at PCPs and that the content was adequate. Finally, the intervention was reviewed and endorsed by the Royal College of GPs, the national professional membership body for family doctors in the UK and overseas.
The involvement of PCPs greatly improved the development of this online intervention and the constant adaptation of the intervention ensured that the PCPs’ needs and preferences were met.
The flowchart below (Figure 1) represents the development process of the intervention.
Developmental process of the intervention.
The complete online intervention consists of two 25-minute modules undertaken sequentially2. The two modules follow a similar format of text on one side and interactive activities on the other side of the screen. Different interactive activities were included such as drag and drop games, patient testimonies or videos.
“Understanding Attention Deficit Hyperactivity Disorder”.
This first module introduces the different aspects of ADHD. Following a brief description of ADHD epidemiology and neuroscience, the core three symptoms are discussed and illustrated by real-life examples. This module also details other symptoms, common misconceptions and the long-term impacts ADHD has on children and adults.
“The role of General Practitioners in ADHD diagnosis and management”.
The second module introduces in more detail the ADHD care pathway and the PCP’s role. Clarifying the PCPs gatekeeping role and specific UK care pathways, this module also details identification, treatment options and the clinical benefits of having good knowledge of ADHD in practice.
Both modules included an “ADHD toolkit” which contained various downloadable forms to support PCPs (such as screening tools, strategies or useful websites).
Following the development of the online training, the usability and efficacy of this intervention were assessed through three clear steps. First, a usability study evaluated PCPs’ experiences of interacting with the intervention and any further changes that might need to be implemented. Secondly, a pilot randomised control trial (RCT) gauged the intervention’s feasibility and explored if it could successfully increase PCPs’ awareness and understanding of ADHD. Thirdly, PCPs’ experiences on whether this intervention impacted their practice were explored through interviews conducted a few months after the intervention.
This preliminary study [45] was conducted to assess the intervention’s acceptability, feasibility and accessibility through a questionnaire. The participants’ evaluative feedback was positive towards the content, design and usability of the online intervention, and little improvement was suggested. The usability study demonstrated that the content of the intervention was accessible, suitable, engaging and informative, validating the co-development approach taken.
Pilot RCT.
A pilot RCT [47] was then conducted to assess the efficacy of the online ADHD training intervention. Participants were blindly randomised to two groups (control or intervention) and had to complete a set of questionnaires evaluating their ADHD confidence, knowledge and attitude at three time points (pre and post-intervention and two-week follow-up). PCPs’ confidence, knowledge and attitude significantly increased after viewing the online training while misconceptions decreased. These findings remained at the two-week follow-up (Figure 2).
Results of ADHD knowledge questionnaire (KADDS, [
Participants from the intervention group were invited to take part in follow-up interviews and a survey after the intervention [47]. The findings from these studies showed that the training had a strong impact on PCPs’ attitudes, knowledge, awareness and practice. PCPs explained that not only were their patients positively impacted by improving access to care but members of the community also (such as colleagues or families). While it was anticipated that PCPs’ knowledge and practice could change from taking part in this study, the acknowledgement of this broader, holistic impact was unexpected.
These three studies allowed the online intervention to be thoroughly assessed. The usability study established the accessibility of the intervention, whilst the pilot RCT and interviews demonstrated its efficacy and its positive impacts on knowledge and practice. These results demonstrate that the online ADHD intervention is highly accessible, usable and efficient. Lack of identification and recognition of ADHD in PCPs can be remediated by PCPs completing a short 45-minute online course, in turn improving patients’ access to care. It indicates that a short online intervention can increase PCPs’ understanding and approach towards ADHD, improving patients’ access to care by impacting their practice.
Previous studies highlighted earlier in this chapter have demonstrated that some of the significant barriers to PCPs’ understanding and management of ADHD are their lack of training, knowledge and presence of misconception. These evaluation studies have shown that a short online education resource can be easily implemented and can address these gaps while also impacting practice. The pilot RCT study [47] (with over 68% of GPs having never received any training on ADHD) and others [4, 38] have highlighted the lack of ADHD training for PCPs. The pilot RCT showed no difference was observed between participants who had and those who had not had ADHD training, indicating that current training is ad-hoc and not effective. This supports previous findings on the strong need for adequate intervention for healthcare professionals, most importantly PCPs [4, 8]. This intervention is, therefore, timely in addressing these gaps.
The main goal of the online resource described in this chapter was to increase PCPs’ understanding and awareness of ADHD. The efficacy of this intervention highlights many positive implications both in terms of future research and in terms of clinical practice.
The choice of online training was a pragmatic one, supported by the PCPs in the co-production phase. Online training is increasingly relied on for healthcare CPD [39] as an accessible learning mode. PCPs expressed their preferences in developing an online resource rather than an app or face-to-face workshops through the development workshops. Similarly to previous studies on online healthcare educational programmes [49, 50], this intervention shows a significant improvement in knowledge, confidence and practice while reducing misconceptions. It is also essential to highlight the benefits of conducting a co-production development process. Tailored online training has been shown to improve PCPs’ knowledge and practice [42, 50]. The evaluation of the PCPs’ intervention supports these findings and highlights the necessity and benefits of developing tailored, co-produced online training for PCPs.
Previous studies presented earlier in this chapter have highlighted significant barriers to accessing care such as lack of ADHD knowledge and lack of recognition [(8, 14, 15], see Section 2.4 for a concise summary). Increasing knowledge and understanding of ADHD from PCPs can lead to many positive outcomes. As such, the online intervention presented aims to:
Increase support given in primary care for ADHD
Increase PCPs’ identification of ADHD
Increase referral to appropriate services
Improve patient’s experiences of seeking a diagnosis by receiving better support and more accurate referrals
Facilitate the diagnosis process, which could lead to reduced waiting lists.
Increasing PCPs’ awareness and identification of ADHD may lead to many clinical benefits by directly impacting patients, their access to care, quality of management and long-term quality of life. Families of patients would also be impacted as the burden of caring for undiagnosed or untreated issues might lessen. Finally, other healthcare professionals would benefit from a better understanding of ADHD from PCPs facilitating better communication and clearer pathways to care.
However, it is important to note that the potential benefits come with ethical considerations. Increased identification and increased referrals might impact demands on specialist services. As such services can often be overstretched [51, 52, 53], increased referrals will directly impact these services. Implications such as long waiting lists and stricter triage systems need to be considered as they could negatively impact the patient.
Future research, both in terms of healthcare research and in other subjects such as education or even policymaking would greatly benefit from the findings of this project.
For instance, a longitudinal evaluation of the long-term impact and implementation of the intervention would strengthen these findings and demonstrate the potential long-term benefits of such interventions. Further studies exploring the participants’ retention of ADHD knowledge and its implementation within their practice in the long term, would greatly inform a more comprehensive implementation of the online training.
The co-developmental process also demonstrated its benefits on interventions’ development. A lot was learned from the PCPs’ involvement in this process, and the final resource was positively different from what was originally proposed without their input, considerably shaping the research. Therefore, future intervention development projects should strongly consider this co-production aspect and the inclusion of end-users in the development process throughout the different stages.
Furthermore, this online intervention could be adapted for other professional groups who experience ADHD in their daily lives (such as other healthcare professionals parents or teachers). Including other stakeholders in the training would allow for a comprehensive overview of the ADHD pathway and clarify the role of all key stakeholders. An adaptation for parents would also support their journey through the care pathway. Parents often wait a very long time for a diagnosis [21] and often have no resources or information on ADHD during that time. A short online resource could increase their understanding and signpost them to support while on the waiting list. Studies have also shown that teachers face similar barriers to PCPs in understanding and knowledge of ADHD [54, 55, 56]. Therefore, an adapted resource for teachers would help address these gaps and facilitate an overall clearer pathway to care for ADHD.
Finally, a better understanding and identification of ADHD will create many wider impacts beyond clinical practice and research. Schools would benefit from having diagnosed children as they can implement adapted educational strategies to manage difficult behaviours, directly impacting school and pupils’ performance and the classroom learning environment. The long-term costs of ADHD can be severe, such as significant academic underachievement and educational problems [57, 58, 59], increased prevalence of depression and anxiety [60, 61], higher rates of offending behaviour and imprisonment [62, 63], divorce [64], driving accidents [65, 66], unemployment [67, 68], suicide [69, 70] and other mental health issues [71]. These considerable risks are attenuated when ADHD is diagnosed, as diagnosis facilitates access to care or support [72]. By gaining early diagnosis and treatment, these factors can be reduced, directly impacting society overall, government bodies and the national healthcare systems.
This chapter presented the latest evidence of the understanding of ADHD in primary care, establishing the barriers and gaps in PCPs’ understanding of ADHD and presenting an innovative tailored psycho-education intervention that addresses these gaps. The efficiency of this resource, its impact and its implementation are also presented.
Barriers to PCPs’ understanding and gaps in their knowledge were identified through evidence-based research and the findings from these studies demonstrate a presence of limited ADHD knowledge and a need for education in primary care.
In order to address these gaps, an online psycho-education intervention was co-produced with PCPs to address the gaps in knowledge and training, reduce misconceptions and clarify the role of PCPs in the ADHD pathway to care. This development process involved multiple steps in order to ensure the most adequate intervention was developed.
This intervention was evaluated through different methods. This evaluation demonstrated that the intervention significantly improved PCPs’ knowledge and attitudes towards ADHD, reduced their misconceptions and impacted their practice. It also highlighted that the intervention was acceptable and feasible. The implications for clinical practice and research are discussed.
It is important to note some limitations of this intervention. Completing the intervention takes approximately 45 minutes; while this is not very long, in PCPs’ day to day practice, this might still be too long. The smartphone layout of the intervention is not as easy to navigate and the videos and the interactive activities have a stronger impact if viewed on a computer. Finally, the second module on the role of the PCP is specific to UK pathways. While the first module on Understanding ADHD is internationally relevant, the second has many country-specific limitations as it aimed to clarify the role of general practitioners (PCPs) within the UK system. Countries with similar pathways to care, however, might also benefit from this resource.
In conclusion, has PCPs’ understanding of ADHD can be very minimal, the development and delivery of a targeted online educational resource demonstrate both a strong need for adequate PCP training and the efficacy of such resources. The use of this intervention benefits many individuals, principally PCPs but also patients, their families and other healthcare providers.
The research studies presented in this chapter were greatly guided by the expertise of Prof. Kapil Sayal, Prof. David Daley, Dr. Charlotte Hall and Dr. Elvira Perez from the University of Nottingham and Dr. Corrie Smith from Lancashire NHS Trust. Their input and feedback were extremely valuable in conducting a thorough research project and implementable intervention. This work was also generously funded by the ESRC.
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These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{id:"56330",doi:"10.5772/intechopen.69932",title:"Russian Scientific Trends on Specific Language Impairment in Childhood",slug:"russian-scientific-trends-on-specific-language-impairment-in-childhood",totalDownloads:1956,totalCrossrefCites:0,totalDimensionsCites:23,abstract:"In Russia, there are many decades of experience in the scientific study of the problem of impaired language development in children. Today, the term “Systemic speech-and-language underdevelopment (SLU)” has firmly established in Russian science and practice, implying a complex developmental disorder of speech and language in children with a primary normal hearing and a conserved intellect, in which the main components of the language system are violated: vocabulary, grammar, phonetics, and, as a consequence, dialogic and monologic speech. Traditionally, a differentiated level-by-level analysis of the speech and language abilities of children is used. The variability of the manifestations and severity of speech-and-language disorders were initially systematized and characterized in four levels of underdevelopment: from the complete absence of phrase speech to the availability of simple and complex sentences with lexico-grammatical errors. Effective algorithms of speech therapist work with SLU are introduced. The effectiveness of the application of these models and algorithms on the material of various language groups is proved.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Tatiana Tumanova and Tatiana Filicheva",authors:[{id:"204529",title:"Dr.",name:"Tatiana Volodarovna",middleName:null,surname:"Tumanova",slug:"tatiana-volodarovna-tumanova",fullName:"Tatiana Volodarovna Tumanova"},{id:"208704",title:"Dr.",name:"Tatiana Borisovna",middleName:null,surname:"Filicheva",slug:"tatiana-borisovna-filicheva",fullName:"Tatiana Borisovna Filicheva"}]},{id:"36452",doi:"10.5772/38931",title:"Qualitative Research Methods in Psychology",slug:"qualitative-research-methods-in-psychology",totalDownloads:35906,totalCrossrefCites:13,totalDimensionsCites:18,abstract:null,book:{id:"1997",slug:"psychology-selected-papers",title:"Psychology",fullTitle:"Psychology - Selected Papers"},signatures:"Deborah Biggerstaff",authors:[{id:"123274",title:"Dr.",name:"Deborah",middleName:null,surname:"Biggerstaff",slug:"deborah-biggerstaff",fullName:"Deborah Biggerstaff"}]},{id:"56560",doi:"10.5772/intechopen.70235",title:"The Role of Speech and Language Therapist in Autism Spectrum Disorders Intervention – An Inclusive Approach",slug:"the-role-of-speech-and-language-therapist-in-autism-spectrum-disorders-intervention-an-inclusive-app",totalDownloads:2377,totalCrossrefCites:2,totalDimensionsCites:16,abstract:"The chapter describes the possibilities of involving a speech-language therapist in the assessment of the pragmatic level of communication in autism spectrum disorders (ASD), where one of the most frequently impaired areas is communication pragmatics. These difficulties lead to a disruption of social interaction, which might be one of the obstacles to speech-language intervention in these children. The text is based on an originally developed testing material aimed at selected pragmatic-oriented communication situations relating to everyday activities and real life. Based on a comparison of domestic and international resources in this area, as well as mediated and own empirical experience, our assessment approach is based on the conclusion that pragmatics can be understood in different contexts and perspectives. The text presents the results of a partial survey comparing the performance of children with ASD and children with typical development. The assessment focused on the children’s election of the correct picture of a pair of pictures that represent usual communication and social situations. The results of the research suggest fewer incorrect responses in children with ASD and in different areas compared with children with typical development. However, the results of a qualitative analysis indicate a necessity to expand the assessment of communication pragmatics by adding an individually specific qualitative analysis of children’s performance.",book:{id:"5957",slug:"advances-in-speech-language-pathology",title:"Advances in Speech-language Pathology",fullTitle:"Advances in Speech-language Pathology"},signatures:"Kateřina Vitásková and Lucie Kytnarová",authors:[{id:"203061",title:"Associate Prof.",name:"Kateřina",middleName:null,surname:"Vitásková",slug:"katerina-vitaskova",fullName:"Kateřina Vitásková"},{id:"212035",title:"MSc.",name:"Lucie",middleName:null,surname:"Kytnarová",slug:"lucie-kytnarova",fullName:"Lucie Kytnarová"}]}],mostDownloadedChaptersLast30Days:[{id:"73271",title:"Social Media and Its Effects on Beauty",slug:"social-media-and-its-effects-on-beauty",totalDownloads:3088,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Beauty is concerned with physical and mental health as both are intimately related. Short-term decisions to alter one’s body structure irrespective of genetic, environmental, occupational and nutritional needs can leave medium- and long-term effects. This chapter analyzes the role of social media and its effects on the standards of beauty. The researchers have summarized the literature on how social media plays a role in affecting beauty trends, body image and self-esteem concerns. There is support that social media affects individuals negatively, in pushing them to engage in life threatening beauty trends due to social compliance and acceptance in society. The aim was to review social networking sites’ impact on perception of standards of beauty and newer unrealistic trends gaining popularity that could alter opinions and also cause harm to individuals in the long run. This is an emerging area of research that is of high importance to the physical and mental health in the beauty, health and hospitality industry with the latter being manifested in depression, anxiety and fear of non-acceptability and being seen as a social gauche.",book:{id:"7811",slug:"beauty-cosmetic-science-cultural-issues-and-creative-developments",title:"Beauty",fullTitle:"Beauty - Cosmetic Science, Cultural Issues and Creative Developments"},signatures:"Mavis Henriques and Debasis Patnaik",authors:[{id:"320016",title:"Ph.D. Student",name:"Mavis",middleName:"Lilian",surname:"Henriques",slug:"mavis-henriques",fullName:"Mavis Henriques"},{id:"320978",title:"Dr.",name:"Debasis",middleName:null,surname:"Patnaik",slug:"debasis-patnaik",fullName:"Debasis Patnaik"}]},{id:"60564",title:"Ageing Process and Physiological Changes",slug:"ageing-process-and-physiological-changes",totalDownloads:7024,totalCrossrefCites:19,totalDimensionsCites:34,abstract:"Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age. According to World Health Organization, ageing is a course of biological reality which starts at conception and ends with death. It has its own dynamics, much beyond human control. However, this process of ageing is also subject to the constructions by which each society makes sense of old age. In most of the developed countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old age. In this chapter, you understand the details of ageing processes and associated physiological changes.",book:{id:"6381",slug:"gerontology",title:"Gerontology",fullTitle:"Gerontology"},signatures:"Shilpa Amarya, Kalyani Singh and Manisha Sabharwal",authors:[{id:"226573",title:"Ph.D.",name:"Shilpa",middleName:null,surname:"Amarya",slug:"shilpa-amarya",fullName:"Shilpa Amarya"},{id:"226593",title:"Dr.",name:"Kalyani",middleName:null,surname:"Singh",slug:"kalyani-singh",fullName:"Kalyani Singh"},{id:"243264",title:"Dr.",name:"Manisha",middleName:null,surname:"Sabharwal",slug:"manisha-sabharwal",fullName:"Manisha Sabharwal"}]},{id:"27237",title:"Emotional Intelligence",slug:"emotional-intelligence",totalDownloads:5779,totalCrossrefCites:6,totalDimensionsCites:9,abstract:null,book:{id:"679",slug:"emotional-intelligence-new-perspectives-and-applications",title:"Emotional Intelligence",fullTitle:"Emotional Intelligence - New Perspectives and Applications"},signatures:"Adrian Furnham",authors:[{id:"85492",title:"Prof.",name:"Adrian",middleName:null,surname:"Furnham",slug:"adrian-furnham",fullName:"Adrian Furnham"}]},{id:"70731",title:"Theoretical Perspective of Traditional Counseling",slug:"theoretical-perspective-of-traditional-counseling",totalDownloads:1610,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter discusses the theoretical perspective of traditional counseling from an African context. Traditional counseling involves a broad perspective that enhances learning for transformation and integration of sociocultural values that are peculiar to each human society. A cursory review of the literature suggests that the concept of traditional counseling is rooted in traditional systems of knowledge and sociocultural customs and practices, and it promotes a collective approach to problem identification, resolution, and management. The traditional counseling process centers on four aspects: traditional counselor, client, family, and community. The key elements that inform the theoretical framework of traditional counseling from an African perspective are: cultural context, collective belief system, and initiation rituals Traditional systems of knowledge deemed essential for each generation are passed on successively to the next generation by elderly people who do not only have the necessary wisdom and experience, but are also adorned with social competences and skills.",book:{id:"9136",slug:"counseling-and-therapy",title:"Counseling and Therapy",fullTitle:"Counseling and Therapy"},signatures:"Hector Chiboola",authors:[{id:"314172",title:"Prof.",name:"Hector",middleName:null,surname:"Chiboola",slug:"hector-chiboola",fullName:"Hector Chiboola"}]},{id:"55388",title:"Beauty, Body Image, and the Media",slug:"beauty-body-image-and-the-media",totalDownloads:7775,totalCrossrefCites:5,totalDimensionsCites:12,abstract:"This chapter analyses the role of the mass media in people’s perceptions of beauty. We summarize the research literature on the mass media, both traditional media and online social media, and how they appear to interact with psychological factors to impact appearance concerns and body image disturbances. There is a strong support for the idea that traditional forms of media (e.g. magazines and music videos) affect perceptions of beauty and appearance concerns by leading women to internalize a very slender body type as ideal or beautiful. Rather than simply being passive recipients of unrealistic beauty ideals communicated to them via the media, a great number of individuals actually seek out idealized images in the media. Finally, we review what is known about the role of social media in impacting society’s perception of beauty and notions of idealized physical forms. Social media are more interactive than traditional media and the effects of self‐presentation strategies on perceptions of beauty have just begun to be studied. This is an emerging area of research that is of high relevance to researchers and clinicians interested in body image and appearance concerns.",book:{id:"5925",slug:"perception-of-beauty",title:"Perception of Beauty",fullTitle:"Perception of Beauty"},signatures:"Jennifer S. Mills, Amy Shannon and Jacqueline Hogue",authors:[{id:"202110",title:"Dr.",name:"Jennifer S.",middleName:null,surname:"Mills",slug:"jennifer-s.-mills",fullName:"Jennifer S. Mills"}]}],onlineFirstChaptersFilter:{topicId:"21",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"83170",title:"Understanding Happiness in the Pacific Islands: A Qualitative Study with University Staff in Fiji",slug:"understanding-happiness-in-the-pacific-islands-a-qualitative-study-with-university-staff-in-fiji",totalDownloads:0,totalDimensionsCites:null,doi:"10.5772/intechopen.106771",abstract:"The concept of happiness has been the subject of critical analysis throughout the Western philosophical thought. Current conceptualizations focus on the role of cultural traditions and consumerist societal values. However, there is increasing scientific evidence that happiness is a product of multiple factors, the specific pattern of which differs across cultures. Yet, the cross-cultural literature tends to condense this into a Western–individualist versus non-Western-collectivist happiness dichotomy. This overlooks the vast diversity in global collectivist societies and more research is needed from under-represented, indigenous populations. This study aims to provide a qualitative exploration of the definitions, experiences, and outcomes of happiness within a professional sample of Indigenous Pacific Fijian and Indian-Fijian ethnic groups. The data revealed eight inter-related themes that, together, suggest the experience of happiness in Fijians is a product of collectivist cultural and religious structures, individual goals and needs, and the practical environment (housing and land systems) of the Pacific Islands. This model of happiness both supports and extends existing literature from other non-Western populations. Importantly, the mix of indigenous, colonial, and environmental influences which seem to underlie the Fijian understanding of happiness support the call for contextualized analyses and socioecological approaches to happiness and well-being research.",book:{id:"11444",title:"Happiness - Biopsychosocial and Anthropological Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11444.jpg"},signatures:"Annie Crookes and Meg A. Warren"},{id:"82771",title:"Making Sense of a Biochemistry Learning Process and Teacher’s Empathy: Computer-Supported Collaborative Learning Using Emoji Symbols",slug:"making-sense-of-a-biochemistry-learning-process-and-teacher-s-empathy-computer-supported-collaborati",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.105927",abstract:"Teaching biochemistry concepts can be a challenging task, as it requires learners and teachers to integrate abstract concepts from chemistry and biology. Students struggle to grasp the molecular processes, as they find it difficult to visualize them. Incorporating Information Communication Technology (ICT) implementations during lessons is known to encourage learners’ involvement in a collaborative learning process and is especially effective when training preservice teachers (PSTs). In the current study, we describe an example in which the teacher plays an important role in creating the Computer-Supported Collaborative Learning (CSCL) in this environment to encourage peer learning while coping with complicated material. We believe that one of the important components in guiding such peer work is the teacher’s ability to sense each group’s progress and to employ empathy in the classroom as a tool for coping with the difficulty and challenge of acquiring new knowledge and for creating a productive dialog between groups that disagree. In this example, the process of Information Communication Technology (ICT) implementation encouraged the preservice teachers (PSTs) to create an alternative set of symbols, which eventually served as a “language” and help them understand the biochemical processes.",book:{id:"11443",title:"Empathy - Advanced Research and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11443.jpg"},signatures:"Dana Sachyani and Ilana Ronen"},{id:"83099",title:"Values-Flow in Contextual Psychotherapy: The ‘What’, ‘Why’, and ‘How’ of Sustainable Values-Based Behaviour",slug:"values-flow-in-contextual-psychotherapy-the-what-why-and-how-of-sustainable-values-based-behaviour",totalDownloads:10,totalDimensionsCites:0,doi:"10.5772/intechopen.106594",abstract:"Flow - enjoyed and fully absorbed engagement in meaningful and contextually bounded activities - is widely underutilised in psychotherapy and mental health settings. Two gold standard therapies, Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT), while powerful and effective in many ways, would benefit from systematic models that move from initiating positive change to sustaining meaningful change. This chapter introduces ‘Values-Flow’ – an approach aimed at building commitment and sustainable engagement in psychotherapy and values-based behaviour in working adults struggling with sub-optimal functioning. We first introduce Values-Flow and describe how it may benefit psychotherapy skills practice in everyday life. Next, we discuss why Values-Flow is relevant and enhances the practice of ACT and DBT strategies, helping to sustain engagement and creative practice of values-based actions outside of sessions. We then describe the ‘Values-Flow’ framework, which incorporates VIVA (Virtue, Involve, Vital, Accepting) and ARIA (Attend, Reflect, Inform, Act) tools that develop commitment for values-based practice in daily life. We conclude with a case-example of how Values-Flow can build commitment and sustainable engagement in homework completion in psychotherapy.",book:{id:"11444",title:"Happiness - Biopsychosocial and Anthropological Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11444.jpg"},signatures:"Cedomir Ignjatovic, Margaret L. Kern and Lindsay G. Oades"},{id:"83100",title:"Factors Affecting the Happiness of Korean University Students",slug:"factors-affecting-the-happiness-of-korean-university-students",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.106296",abstract:"As of 2020, in Korea, as 72.5% of high-school graduates go on to college and college period has an impact on the social development of Korean youth, it is very important to increase the sense of happiness of college students. However, there are new terminologies to express the situation in which how young people in Korea feel the difficulties in their lives, such as “Hell Chosun, 88-Dollar-Generation, N-Give-up-Generation, and Spoon-Social-Rank.” This chapter summarizes the factors related to the happiness of college students in South Korea, such as depression, interpersonal relationships, and self-efficacy, to suggest educational programs to promote the happiness of young people in Korea.",book:{id:"11444",title:"Happiness - Biopsychosocial and Anthropological Perspectives",coverURL:"https://cdn.intechopen.com/books/images_new/11444.jpg"},signatures:"Soo-Koung Jun"},{id:"83107",title:"Helping BIPOC LGBTQIA+ Families Through Inclusive Therapy and Advocacy",slug:"helping-bipoc-lgbtqia-families-through-inclusive-therapy-and-advocacy",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.106695",abstract:"Families are phenomenological and unique. All families are valuable, but historically, many family types have been underrepresented. Families with members who identify in the BIPOC LGBTQIA+ communities have historically been underrepresented and marginalized. Helping BIPOC LGBTQIA+ families involves both clinical work and advocacy. Advocacy for the professional identity of counseling, marriage and family therapy, and related helpers involves various aspects. These aspects include leadership theory and integration, importance of professional identity, the need to continue to infuse multiculturalism within the counseling and family therapy identities, and continued skills for counselors to learn inclusive advocacy. Skills and implications for advocacy as they relate to clients who intersect among the LGBTQAI+ and BIPOC communities, will be described.",book:{id:"11781",title:"Family Therapy - Recent Advances in Clinical and Crisis Settings",coverURL:"https://cdn.intechopen.com/books/images_new/11781.jpg"},signatures:"Lucy Parker-Barnes, Noel McKillip and Carolyn Powell"},{id:"83027",title:"Coping Strategies and Meta-Worry in Adolescents’ Adjustment during COVID-19 Pandemic",slug:"coping-strategies-and-meta-worry-in-adolescents-adjustment-during-covid-19-pandemic",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.106258",abstract:"With the beginning of the COVID-19 pandemic, several limitations and stressful changes have been introduced in adolescent’s daily life. Particularly, Italian teenagers were the first among western populations to experience fears of infection, home confinement, and social restrictions due to a long lockdown period (10 weeks). This study explores the role of coping strategies (task-oriented, emotion-oriented, and avoidance coping) and meta-beliefs about worry as vulnerability factors associated with adolescents’ anxiety. A community sample of adolescents (N = 284, aged 16–18 y.o.) answered questionnaires assessing anxiety symptoms (RCMAS-2), meta-cognitive beliefs and processes about worry (MCQ-C), and coping strategies (CISS). Results show that 37% of participants report clinically elevated anxiety. Emotion-centered coping predicted higher anxiety, whereas task-centered coping resulted associated with decreased anxiety. Cognitive monitoring about their own worry contributes, but to a lesser extent, to higher levels of anxiety. The implications for the intervention are discussed, especially the need to enhance the coping skills of adolescents and mitigate the stress of the COVID-19 pandemic, which could last for a long time.",book:{id:"10671",title:"Adolescences",coverURL:"https://cdn.intechopen.com/books/images_new/10671.jpg"},signatures:"Loredana Benedetto, Ilenia Schipilliti and Massimo Ingrassia"}],onlineFirstChaptersTotal:69},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:11,numberOfPublishedChapters:91,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:108,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:333,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:11,numberOfPublishedChapters:144,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:126,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:23,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:13,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 17th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Rosa María Martínez-Espinosa is a Full Professor of Biochemistry and Molecular Biology at the University of Alicante, Spain, and has been the vice president of International Relations and Development Cooperation at this university since 2010. She created the research group in applied biochemistry in 2017 (https://web.ua.es/en/appbiochem/), and from 1999 to the present has made more than 200 contributions to Spanish and international conferences. Furthermore, she has around seventy-five scientific publications in indexed journals, eighty book chapters, and one patent to her credit. Her research work focuses on microbial metabolism (particularly on extremophile microorganisms), purification and characterization of enzymes with potential industrial and biotechnological applications, protocol optimization for genetically manipulating microorganisms, gene regulation characterization, carotenoid (pigment) production, and design and development of contaminated water and soil bioremediation processes by means of microorganisms. This research has received competitive public grants from the European Commission, the Spanish Ministry of Economy and Competitiveness, the Valencia Region Government, and the University of Alicante.",institutionString:"University of Alicante",institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:45,paginationItems:[{id:"83122",title:"New Perspectives on the Application of Chito-Oligosaccharides Derived from Chitin and Chitosan: A Review",doi:"10.5772/intechopen.106501",signatures:"Paul Edgardo Regalado-Infante, Norma Gabriela Rojas-Avelizapa, Rosalía Núñez-Pastrana, Daniel Tapia-Maruri, Andrea Margarita Rivas-Castillo, Régulo Carlos Llarena-Hernández and Luz Irene Rojas-Avelizapa",slug:"new-perspectives-on-the-application-of-chito-oligosaccharides-derived-from-chitin-and-chitosan-a-rev",totalDownloads:1,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chitin-Chitosan - Isolation, Properties, and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/11670.jpg",subseries:{id:"15",title:"Chemical Biology"}}},{id:"83015",title:"Acute Changes in Lipoprotein-Associated Oxidative Stress",doi:"10.5772/intechopen.106489",signatures:"Ngoc-Anh Le",slug:"acute-changes-in-lipoprotein-associated-oxidative-stress",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:[{name:"Anh",surname:"Le"}],book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}},{id:"83041",title:"Responses of Endoplasmic Reticulum to Plant Stress",doi:"10.5772/intechopen.106590",signatures:"Vishwa Jyoti Baruah, Bhaswati Sarmah, Manny Saluja and Elizabeth H. Mahood",slug:"responses-of-endoplasmic-reticulum-to-plant-stress",totalDownloads:5,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Endoplasmic Reticulum",coverURL:"https://cdn.intechopen.com/books/images_new/11674.jpg",subseries:{id:"14",title:"Cell and Molecular Biology"}}},{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:16,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. 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Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a scientist and Principal Investigator at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering the lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via artificial intelligence-based analyses of exosomal Raman signatures. Dr. Paul also works on spatial multiplex immunofluorescence-based tissue mapping to understand the immune repertoire in lung cancer. Dr. Paul has published in more than sixty-five peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award and the 2022 AAISCR-R Vijayalaxmi Award for Innovative Cancer Research. He is a senior member of the Institute of Electrical and Electronics Engineers (IEEE) and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"9",type:"subseries",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. 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