Biomedical subjects

C K Haddock

Publications and source records attributed to C K Haddock.

At least 19 recordsLinked to original sources

PubMed2006

Tobacco use among medical professionals in Kerala, India: the need for enhanced tobacco cessation and control efforts.

In developing nations where reductions in tobacco use have not been realized, it is critical that health professionals be encouraged to abstain from tobacco use. Data on tobacco use among health professionals in India are limited. We conducted cross-sectional surveys among 110 male medical school faculty (MSF), 229 physicians (67% male), 1130 medical students (46% male), and 73 female nursing students. Information on tobacco use and quit attempts was collected using structured questionnaires. Among the male respondents, current smokers were 15.1% of MSF, 13.1% of physicians, and 14.1% of medical students. Among current smokers, 42% of MSF and physicians and 51% of medical students had not attempted quitting in the last year. However, one third of MSF and physicians and 16% of medical students had attempted to quit at least 4 times. This is one of the first studies among health care professionals in India. Our findings show that a substantial proportion of physicians and medical students in Kerala continue to smoke. Smoking cessation programs are warranted in medical schools in Kerala. An initiative is presently underway by the authors to incorporate tobacco education into the medical school curriculum.

Adult↗

PubMed2006

Does metabolic syndrome mitigate weight loss in overweight Mexican American women treated for 1-year with orlistat and lifestyle modification?

AIMS: To investigate the effects of a pharmacotherapy (orlistat) plus lifestyle management (OLM) intervention on weight loss in Mexican American women with and without metabolic syndrome (MS). METHODS: One hundred and seven female participants aged 21-65 years and of Mexican origin were randomized to either OLM or a wait-list control group (WLC) for one year. The lifestyle interventions were tailored to exhibit features of the Mexican culture. Within each group, subjects with MS were compared to those without MS to assess whether its presence mitigates weight loss. Risk factors for MS also were assessed. RESULTS: Participants with MS in the OLM group experienced significant decreases in weight and body mass index (BMI) as compared to participants without MS. Participants with MS in the OLM group and who completed the study lost 9.3+/-7.5 kg (20.5+/-16.5 lb) as compared to participants with MS in the WLC group, who only lost 0.2+/-3.1 kg (0.4+/-6.8 lb). Further, participants with MS in the OLM group who completed the study experienced a 3.1+/-3.9 kg/m2 decrease in BMI whereas participants with MS in the WLC group only experienced a 0.1+/-1.2 kg/m2 decrease in BMI. No changes in other MS risk factors were significant. CONCLUSIONS: Patients with MS experienced significant weight loss and decreases in BMI as a result of a lifestyle and pharmacotherapy intervention.

Adult↗

PubMed2006

Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat.

OBJECTIVE: There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre. METHODS: Participants (N = 250) with body mass index (BMI) >or=27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated. RESULTS: Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean +/- SD: -3.8 +/- 5.8 kg and -4.8 +/- 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (-1.7 +/- 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 +/- 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. CONCLUSIONS: Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits.

Adult↗

PubMed2005

Weight loss with meal replacement and meal replacement plus snacks: a randomized trial.

OBJECTIVE: To evaluate whether snacking would improve weight loss and weight maintenance in overweight individuals within the context of a structured meal replacement (MR) weight loss program. DESIGN: A prospective 24 week, 2 (snacking vs nonsnacking) x 2 (MR vs meal replacement augmented with snacks (MRPS)) randomized trial. Participants were instructed to limit their total daily intake to 1200 (women) or 1500 (men) kcals. Those receiving the MR program were instructed not to snack while those in the MRPS program were told to snack three times per day. SUBJECTS: A total of 100 participants were block-randomized, based on prestudy snacking status (high vs low), to receive a standard meal replacement program (MR) or MRPS. MEASUREMENTS: Weight, height, blood pressure, lipid fractions, glucose, and insulin were assessed at the baseline, 12-, and 24 weeks. RESULTS: Completers analysis at 24 weeks demonstrated a significant time effect (F(1,46)=44.6, P<0.001), indicating that all participants lost significant amounts of weight regardless of group assignment. An intention-to-treat model resulted in similar results. By week 24, the average weight loss across groups was 4.6 kg. There also were significant improvements across all groups among completers for systolic blood pressure (P=0.047), cholesterol (P=0.001), LDL (P=0.001), glucose (P=0.004), and insulin (P=0.001) at week 12, and glucose (P=0.001) and insulin at week 24 (P=0.003). CONCLUSIONS: Our results suggest that a participant's preferences for snacking did not affect their response to treatment. Snackers and nonsnackers responded equally well whether they received a standard meal replacement program or one augmented with snacks.

Adult↗

PubMed2003

Weight loss in obese Mexican Americans treated for 1-year with orlistat and lifestyle modification.

OBJECTIVE: To evaluate the effectiveness of a culturally appropriate lifestyle intervention combined with orlistat in producing weight loss with obese Mexican-American women. SUBJECTS: Mexican-American women (N=108), aged 21-65 y, with a body mass index (BMI) > or =27 kg/m(2) were randomized to 1 y of treatment with orlistat and a culturally tailored lifestyle modification intervention (OLM; n=56) or a wait-list control group (WLC; n=52). DESIGN: A randomized, controlled, open-label 12-month study. Orlistat was dosed at 120 mg, three times per day. The OLM intervention included behavior modification, a low-fat (< or =30% of total daily calories) diet, and moderate physical activity (> or =150 min/week). MEASUREMENT: Primary outcomes included changes in body weight (kg), BMI, waist circumference, blood pressure, glucose, and lipids. RESULTS: A total of 72 (37 OLM, 35 WLC) and 66 participants (32 OLM, 34 WLC) completed the 6- and 12-month follow-ups, respectively. Repeated-measures ANOVA demonstrated a significant time x treatment interaction (Wilks' lambda=12.61; P<0.001), indicating that OLM-treated patients achieved significant weight loss relative to the WLC group during the study (mean percentage weight loss+/-s.e.m.; -8.1%+/-1.2 vs -1.6%+/-0.7 at 6 months and -8.8%+/-1.5 vs -0.2%+/-1.0 at 12 months, respectively). OLM-treated patients also experienced significant reductions in waist circumference, low-density-lipoprotein, and total cholesterol. CONCLUSIONS: This study demonstrates the effectiveness of an intervention combining orlistat and lifestyle modification with Mexican-American women, a population with substantial risk for obesity.

Adult↗

PubMed2002

Physical activity does not mitigate G-protein-related genetic risk for obesity in individuals of African descent.

The G-protein beta3 subunit 825 TT genotype has been associated with obesity and hypertension. We examined the interaction between the G-protein TT genotype, physical activity and body mass index (BMI) in a cross-sectional study of African immigrants and African Americans. The genotype frequencies were 6.3% CC, 37.7% CT, and 56% TT. After adjusting for potential confounders, BMI was found to be significantly higher in the sedentary than in the physically active participants (p=0.045). There was no statistically significant effect for genotype (p=0.215) or the interaction between genotype and the level of physical activity (p=0.219). However, the individuals with the CC or CT genotype who were physically active had substantially lower BMIs (M+/-SE) (i.e., 25.74+/-2.02) than any of the other groups: sedentary CC + CT (30.58+/-1.03), sedentary TT (30.65+/-1.00) or active TT (29.43+/-1.65). Because of the low statistical power of this study, further research is needed to confirm these findings and to explore potential gene-environment/lifestyle interactions.

Adult↗

PubMed2002

Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials.

AIM: This article provides the first comprehensive meta-analysis of randomized clinical trials of medications for obesity. METHOD: Based on stringent inclusionary criteria, a total of 108 studies were included in the final database. Outcomes are presented for comparisons of single and combination drugs to placebo and for comparisons of medications to one another. RESULT: Overall, the medications studied produced medium effect sizes. Four drugs produced large effect sizes (ie d>0.80; amphetamine, benzphetamine, fenfluramine and sibutramine). The placebo-subtracted weight losses for single drugs vs placebo included in the meta-analysis never exceeded 4.0 kg. No drug, or class of drugs, demonstrated clear superiority as an obesity medication. Effects of methodological factors are also presented along with suggestions for future research.

Amphetamines↗

PubMed2001

Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males.

BACKGROUND: This study was designed to test the hypothesis that smokeless tobacco (SLT) serves as a gateway drug for smoking among young adult males. Methods. A cohort (n = 7,865) of U.S. Air Force recruits who claimed to have never smoked cigarettes was followed prospectively for 1 year. The participants were male, 32.9% were ethnic minorities, and their average age was 19.84 years (SD = 2.29). Among recruits entering basic military training, 403 (5.1%) reported current SLT use and 198 (2.5%) reported a past history of SLT use. RESULTS: At the 1-year follow-up current SLT users were 233% more likely to have initiated smoking than nonusers (odds ratio = 2.33, 95% CI = 1.84-2.94). Similarly, recruits who reported past SLT use were 227% more likely to begin smoking than participants who had never used SLT (odds ratio = 2.27, 95% CI = 1.64-3.15). SLT use remained a potent predictor of smoking initiation in a multivariate logistic model that included demographic factors and other risk factors for initiation. CONCLUSIONS: SLT use appears to be an important predictor of smoking initiation among young adult males. This study suggests that smoking prevention and cessation programs should also include strategies related to SLT use.

Adolescent↗

PubMed2001

Lifestyle treatments in randomized clinical trials of pharmacotherapies for obesity.

OBJECTIVE: This meta-analysis evaluated the types of lifestyle treatments used in published obesity drug studies and assessed their contribution to weight losses associated with pharmacological interventions. RESEARCH METHODS AND PROCEDURES: Randomized, placebo-controlled, double-blind clinical trials of anti-obesity agents that are/were Food and Drug Administration-approved for the treatment of obesity (both prescription and over-the-counter), and drugs that are Food and Drug Administration-approved and are used off-label for obesity were included. Studies were located by computer searches of databases (e.g., Medline, PsychInfo) and reviewing tables of content/reference sections of journals, abstracts, previous reviews, past empirical studies, relevant book chapters, and recent issues of journals that regularly publish obesity research. In addition, a number of individuals who regularly publish in the obesity literature were asked to provide personal lists of obesity-drug studies. Based on the above criteria, a total of 108 randomized clinical trials were located. RESULTS: Balanced-deficit diets, low-calorie diets, and self-monitoring were the most used lifestyle treatments in published obesity studies. They were incorporated into 40.7%, 25%, and 23.1% of pharmacotherapy studies, respectively. Physical activity and other behavioral or psychotherapeutic interventions rarely were used. A substantial portion of weight loss experienced by patients was attributable to both "placebo effects" and to the lifestyle treatments. DISCUSSION: Obesity-pharmacotherapy trials do not use lifestyle treatments with the frequency expected based on the official positions of most professional organizations concerned with the comprehensive management of obesity.

Anti-Obesity Agents↗

PubMed2001

Genetic bottlenecks, perceived racism, and hypertension risk among African Americans and first-generation African immigrants.

The complexity of factors influencing the development of hypertension (HTN) in African Americans has given rise to theories suggesting that genetic changes occurred due to selection pressures/genetic bottleneck effects (ie, constriction of existing genetic variability) over the course of the slave trade. Ninety-nine US-born and 86 African-born health professionals were compared in a cross-sectional survey examining genetic and psychosocial predictors of HTN. We examined the distributions of three genetic loci (G-protein, AGT-235, and ACE I/D) that have been associated with increased HTN risk. There were no significant differences between US-born African Americans and African-born immigrants in the studied genetic loci or biological variables (eg, plasma renin and angiotensin converting enzyme activity), except that the AGT-235 homozygous T genotype was somewhat more frequent among African-born participants than US-born African Americans. Only age, body mass index, and birthplace consistently demonstrated associations with HTN status. Thus, there was no evidence of a genetic bottleneck in the loci studied, ie, that US-born African Americans have different genotype distributions that increase their risk for HTN. In fact, some of the genotypic distributions evidenced lower frequencies of HTN-related alleles among US-born African Americans, providing evidence of European admixture. The consistent finding that birthplace (ie, US vs Africa) was associated with HTN, even though it was not always significant, suggests potential and unmeasured cultural, lifestyle, and environmental differences between African immigrants and US-born African Americans that are protective against HTN.

Adult↗

PubMed2001

The association of smoking and the cost of military training.

OBJECTIVE: To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING: A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES: Excess training costs as a result of premature discharge. RESULTS: In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS: Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with $18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over $130 million per year in excess training costs.

Adult↗

PubMed2000

Does personality or psychopathology predict disability in chronic pain patients?

PURPOSE: The purpose of this study was to evaluate the usefulness of personality characteristics, depression and personality disorders in predicting disability status in pain patients one year later. METHOD: Subjects were 250 volunteer chronic pain patients. The baseline evaluation consisted of the Karolinska Scales of Personality and psychiatric evaluation of depression and personality disorders using standardized diagnostic instruments. Disability status was assessed by insurance record review one year after the evaluation. RESULTS: The results suggest that baseline personality traits and psychopathology (i.e. depression or personality disorders) were not useful predictors of disability status in pain patients with one-year follow-up. CONCLUSIONS: These data suggest that personality characteristics and psychopathology are probably not important disability predictors in chronic pain patients.

Adult↗

PubMed2000

Ethnic differences in patterns and correlates of age of initiation in a population of Air Force recruits.

Early age of initiation is a significant risk factor for long-term dependent smoking and may also relate to other unhealthy behaviors. The current study assessed age of initiation in relationship to smoking dependence and motivation to quit, physical activity, dietary intake, body mass index (BMI), attitude toward illegal drug use, binge drinking, seat belt use, and smoking status at follow-up. Subjects were 7995 Air Force recruits who reported smoking regularly up to Basic Military Training. Euro-Americans initiated smoking more than a year earlier on average (15.5 years) than did African-Americans (16.8 years), with Hispanic-Americans (16.0 years) between these two groups. No gender differences were found for age of initiation for any ethnic group. Early age of initiation in Euro-Americans was associated with greater dependence on tobacco, reduced motivation to quit, less likelihood of quitting in the next 12 months, and a number of other health risk factors including lower self-reported physical activity, greater intake of high-fat foods, more favorable attitudes toward illegal drugs, increased likelihood of binge drinking, and less reported use of seat belts. Relationships between early age of initiation and other unhealthy behaviors were less consistent for African-Americans and for neither African-Americans nor Hispanics did age of initiation predict smoking status at 1-year follow-up.

Adolescent↗

PubMed2000

The pediatrician's role in reducing tobacco exposure in children.

OBJECTIVE: Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem. METHODOLOGY: A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence. RESULTS: A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents. CONCLUSIONS: Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.

Adolescent↗

PubMed2000

Behavioral treatment of insomnia: the Wilford Hall Insomnia Program.

Persistent insomnia is one of the most common patient complaints reported in primary care settings. This paper reviews the behavioral assessment and treatment approaches for persistent insomnia and reports the results of 42 consecutively treated patients in the Wilford Hall Insomnia Program. Patients were treated in a six-session, multiple-component behavioral group treatment program consisting of sleep restriction, stimulus control, sleep hygiene, relaxation training, and cognitive therapy. In addition, patients were seen for two individual treatment sessions in conjunction with the program and for two individual post-group treatment sessions to assess treatment progress. The results indicated that sleep onset latency was improved by 53%, wake after sleep onset was decreased by 40%, and sleep efficiency was improved by 22%. A detailed description of the behavioral treatment program for insomnia is provided as well as recommendations for practitioners working in primary care settings.

Behavior Therapy↗

PubMed2000

Demographic, lifestyle, and psychosocial predictors of frequency of intoxication and other indicators as estimates of alcohol-related problems in Air Force basic military recruits.

This study examined demographic, lifestyle, and psychosocial variables to determine predictors of Air Force recruits who are likely to have alcohol-related problems. Subjects were all Air Force recruits (N = 32,144) entering basic training from August 1995 to September 1996. The dependent measures were self-reported frequency of eight or more drinks per occasion, frequency of fighting while drinking, and typical frequency of alcohol consumption. Demographic analysis revealed that individuals high on any dependent variable were more likely to be male, older, non-Hispanic whites with some college. Lifestyle predictors included positive attitudes toward drug use and smoking status, with risk greater for females than males and for non-whites than non-Hispanic whites at the same smoking level. Psychosocial predictors included positive rebellious attitudes, decreased seatbelt use, and positive risk-taking attitudes, with risk greater for females than males at the same risk attitude level. These findings suggest that problem drinking falls into a broader category of risky problem behaviors.

Adolescent↗

PubMed2000

Relapse to smoking after basic military training in the U.S. Air Force.

This study examined predictors of smoking relapse in the year after the mandatory smoking ban during basic military training (BMT) in the U.S. Air Force. Participants were all smokers who completed BMT from August 1995 to August 1996 and relapsed to smoking in the subsequent year (N = 4,303). Results demonstrated that the vast majority of airmen (69.8%) returned to smoking within 1 month after BMT and that most (90%) were still in training status when they smoked their first cigarette after BMT. Relapsed smokers appeared more motivated to quit smoking at 1-year follow-up compared with when they were in BMT. Individuals making serious quit attempts after BMT were younger and had greater levels of physical activity, more confidence in quitting, and more favorable perceptions of the BMT ban than individuals not attempting to quit. Based on these findings, recommendations are discussed for improving abstinence rates after BMT.

Adolescent↗

PubMed1999

An examination of cigarette brand switching to reduce health risks.

This study examined cigarette brand switching to reduce health risks in a population of young smokers (N = 7,998) entering United States Air Force Basic Military Training. Because of a comprehensive tobacco ban during training, all smokers were abstinent during the study. Results from this investigation suggested that brand switching to reduce health risks was common among current smokers (31.3% of males; 32.3% of females). Brand switchers smoked fewer cigarettes, were more likely to smoke low-yield brands, had lower scores on a measure of nicotine dependency, and were more confident they could remain abstinent following training. Other discriminators of smokers who had switched brands from other smokers included using smoking to control appetite, greater proclivity to attempt smoking cessation, engaging in fewer safety risks, and healthier dietary composition. Finally, brand switchers quit smoking at a higher rate than other smokers (12.5% versus 11.1%) during the year following basic military training. However, a multivariate logistic regression model that controlled for demographic factors and smoking history suggested that brand switching was not a statistically significant predictor of smoking cessation during the follow-up period.

Adaptation, Psychological↗