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Biomedical subjects

E W Kligman

Publications and source records attributed to E W Kligman.

At least 19 recordsLinked to original sources
PubMed1992

Preventive nutrition: an 'optimal' diet for older adults.

Nutritional screening, an important aspect of prevention, includes measurement of height and weight, laboratory values as indicated, and a dietary assessment. For primary prevention, nutrition information should be broad enough to maintain health and prevent disease in healthy persons. Recommendations need to address problems of dietary excess as well as the possibility of nutrient inadequacy. Although controversial, the routine recommendation of a basic multivitamin and mineral supplement for healthy older adults is favored by these authors.

Aged↗
PubMed1992

Preventive nutrition: disease-specific dietary interventions for older adults.

Disease prevention through dietary management is a cost-effective approach to promoting healthy aging. Fats, cholesterol, soluble fiber, and the trace elements copper and chromium affect the morbidity and mortality of CHD. Decreasing sodium and increasing potassium intake improves control of hypertension. Calcium and magnesium may also have a role in controlling hypertension. The antioxidant vitamins A and beta-carotene, vitamin C, vitamin E, and the trace mineral selenium may protect against types of cancer. A decrease in simple carbohydrates and an increase in soluble dietary fiber may normalize moderately elevated blood glucose levels. Deficiencies of zinc or iron diminish immune function. Adequate levels of calcium and vitamin D can help prevent senile osteoporosis in both older men and women.

Aged↗
PubMed1992

Healthier lifestyles: how to motivate older patients to change.

A 1- to 3-minute clear discussion by the family physician of the risks of unhealthy lifestyles has been found to be quite successful in countering patients' denial of personal risk. Studies indicate that the physician's authority lends credibility to the need to make a change and is a strong motivator. An office-based physician counseling model has proven effective in motivating older patients to adopt healthier lifestyles. The model includes four basic steps: patient assessment, discussion of risk and delivery of a message to change, a prescription for change (planning and carrying out of a behavior change strategy), and prevention of relapse through a maintenance program.

Aged↗
PubMed1992

Increasing physician screening and counseling for passive smoking.

BACKGROUND: The adverse health effects of passive smoking on children, including increased respiratory tract illnesses and otitis media, are well documented. A child's visit to a physician for these illnesses represents a "teachable moment" to screen for household smokers and to counsel parents regarding the health effects of passive smoking. Whether physicians are performing these activities in their offices is unknown. We hypothesized that screening and counseling by physicians with regard to passive smoking would be low in this setting and that these activities could be increased by a simple, two-part intervention. METHODS: We used chart audits and postvisit parental surveys to assess the preintervention and postintervention screening and counseling activities of physicians with regard to passive smoking. The two-part intervention consisted of a 2-hour educational seminar for the physicians and a passive smoking chart reminder and documentation system. RESULTS: In comparing the preintervention with the post-intervention parental surveys, there were increases in the passive smoking screening (17% vs 32%, P = .03) and counseling (19% vs 46%, P = .03) activities of physicians. Chart documentation of these activities, however, showed very little change regarding screening (2% vs 6%, P = .19) or counseling (4% vs 6%, P = .64). CONCLUSIONS: These results indicate initially low rates of passive smoking screening and counseling of parents by physicians during acute illness visits of their children. These data also indicate that a simple two-part intervention was very useful in increasing passive smoking screening and counseling activities by physicians in this setting.

Child, Preschool↗
PubMed1992

Preventive geriatrics: basic principles for primary care physicians.

The goal of preventive geriatrics is to nurture a state of health that allows maximal active life expectancy while maintaining high levels of function. The physician's role in promoting such a state of health is disease prevention and the control of chronic diseases of aging. Barriers such as insufficient time and/or staff resources and insufficient third-party reimbursement restrict the delivery of multiple risk factor intervention and healthy aging counseling in the office setting. A systematic approach to preventive geriatrics proposed by the U.S. Prevention Services Task Force is discussed.

Aged↗
PubMed1992

Prescribing physical activity for older patients.

Regular exercise is an effective nonpharmacologic therapy for stress, sleep disorders, depression, and anxiety, as well as such chronic conditions of aging as hypertension, obesity, diabetes mellitus, coronary artery disease, hyperlipidemia, and constipation. Pre-exercise office assessment of cardiac risk, possible limitations, and contraindications is advised. A balanced fitness training program includes activities to increase flexibility, strength, and cardiovascular endurance. The most effective exercise prescription begins with a type of aerobic activity the patient enjoys. A prescribed schedule of stepwise increments in frequency, duration, and intensity gradually leads to a maintenance level of fitness.

Aged↗
PubMed1992

Treatment of otitis media.

Amoxicillin is the first-line drug for otitis media. Effective second-line drugs for resistant beta-lactamase-producing bacterial strains include trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil and cefixime. In choosing an antibiotic, the physician should consider proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage and the age of the child. Children with recurrent infections may benefit from antibiotic prophylaxis. About 10 percent of children with episodes of acute otitis media develop a chronic middle ear effusion that persists beyond three months. Referral for insertion of tympanostomy tubes is most appropriate for patients with documented language delay and/or significant medical complications.

Algorithms↗
PubMed1992

Screening persons aged 65 and older for coronary heart disease risk factors.

Because of limited clinical investigations addressing the effectiveness of intervention to reduce known risk factors, it is difficult for primary care physicians to decide on which coronary heart disease risk factors to continue to screen for among older patients. The recently published report of the United States Preventive Services Task Force, using explicit screening criteria, has recommended that several risk factors be investigated for use among older adults. Recent longitudinal studies have found that a number of risk factors persist with advancing age-hypertension, left ventricular hypertrophy, impaired glucose metabolism, elevated cholesterol levels, obesity, smoking, physical inactivity, decline in vital capacity, and increased heart rate. Screening to identify many of these risks and treatment and counseling to modify them appear to improve survival. Evidence is less clear that diabetes mellitus and elevated cholesterol levels have the same significance for men and women as they age. Left ventricular hypertrophy and diabetes seem particularly important as risk factors for older women, whereas a high heart rate may be a greater risk for men.

Aged↗
PubMed1991

Office evaluation of sexual function and complaints.

The maintenance of sexual function is becoming a concern of patients as they live longer. Because over 80% of sexual complaints can be successfully managed in the primary care setting, it is important for physicians to include an evaluation of sexual health in the routine health examination. Physicians need to appreciate the spectrum of sexual function among older patients, which includes emotional intimacy, touching, and caressing as sexual activity as well as intercourse. For the majority of older people, sexual function may continue into their ninth and tenth decades. As people age, the prevalence of sexual dysfunction increases, most often because of the unavailability of a healthy partner, the prevalence of comorbid physical and psychologic problems, and the interaction of medications and substances used; thus, common sexual complaints of the elderly are multifactorial. To evaluate the older patient effectively, physicians must overcome a number of barriers, including their lack of formal training in therapy and counseling, personal myths regarding sexual function in old age, time and financial restraints, and a lack of patient comfort in discussing sexual problems. The sexual history should be nonthreatening, include general questions followed by more specific ones to elicit specific sexual concerns, and incorporate a thorough review of medications. The physical examination should concentrate on identifying signs of androgen deficiency, estrogen excess, vascular disease, and neurologic dysfunction. Few laboratory tests are required for the routine evaluation of common complaints. This problem-oriented evaluation approach is usually sufficient to identify one or more of the causes of sexual problems: the normal aging climacteric, disuse, physiologic dysfunction or physical illness, psychologic illness, or iatrogenic causes. Initial treatment by the primary care physician often begins with general counseling and education. Counseling should focus on eliminating medications that can interfere with sexual function, granting permission to patients to express themselves sexually in a variety of ways, educating patients on more comfortable positions for sexual activity and other lifestyle changes to make sexual expression safer and more comfortable. It also is important for the primary physician to know when to refer patients for further treatment.

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PubMed1990

Comprehensive geriatric assessment recommendations: adherence of family practice residents.

A study was performed to determine whether family practice residents followed recommendations made by a comprehensive geriatric assessment clinic. Of 109 consecutive consultations, 27 patients had follow-up visits with family practice residents who participated in the assessment and who subsequently served as their primary care physicians. Adherence of residents to 437 clinic recommendations was monitored for 90 days by medical record review. Although recommendations to begin or increase a medication were followed 85.4% of the time, residents followed recommendations to stop or decrease medications less than 65% of the time. Recommendations to order a specific laboratory test or x-ray examination were acted on 70.3% of the time. Preventive recommendations were followed only 54.3% of the time. Residents' adherence to team-based care plans varied widely by type of recommendation. Special efforts are needed to increase compliance with comprehensive geriatric assessment clinic recommendations, particularly those for preventive services.

Aged↗
PubMed1990

Reducing the exposure of children to environmental tobacco smoke. An office-based intervention program.

It is important for the family physician to consider a spectrum of screening tests, counseling topics, and childhood immunizations when providing acute and chronic care, in addition to well-child care. The effectiveness of specific clinical preventive services in eliciting positive health outcomes and age-related guidelines to prioritize health promotion activity have recently been reviewed by the US Preventive Services Task Force. Given recent studies identifying environmental tobacco smoke as a risk factor for children by being associated with an increase in the incidence and severity of respiratory tract and ear infections, family physicians should be routinely screening parents, especially during visits that provide teachable moments for counseling and intervention. Family physicians need to be aware of possible responses parents may have to their counseling and provide nonjudgmental information and guidance throughout a child's early years of development.

Child, Preschool↗
PubMed1989

Drug therapy for hypertension in the elderly.

Essential hypertension is a major health care problem in the elderly and requires effective treatment to reduce morbidity and mortality. The traditional stepped-care approach to therapy consisted of diuretics; sympatholytic agents, or beta-blockers for all age groups. Indeed, initial therapy with these agents is effective in 50 to 60 percent of elderly patients but may produce adverse effects. A high incidence of adverse responses, including sexual dysfunction and central nervous system impairment, has been reported with diuretic or beta-blocker therapy, and a reduction in several measures of quality of life has been noted during therapy with methyldopa or propranolol. Administration of an angiotensin-converting enzyme (ACE) inhibitor is as effective as the traditional stepped-care approach without producing the ill effects associated with diuretics, sympatholytics, or beta-blockers. The combination of an ACE inhibitor with a diuretic produces additive antihypertensive effects while minimizing diuretic-induced metabolic alterations. Orthostatic hypotension with the first dose can be minimized by making sure that patients are not hypovolemic from previous diuretic therapy. Nevertheless, in controlled trials, the combination of ACE inhibitor and diuretic has been effective in up to 85 percent of patients. In addition, the use of ACE inhibitors may be beneficial in the hypertensive patient with concomitant congestive heart failure. Most important, the patient's quality of life is maintained during therapy with an ACE inhibitor alone or in combination with a diuretic. Thus, an ACE inhibitor plus a diuretic is a valuable alternative to traditional antihypertensive therapy in elderly patients.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Screening for coronary heart disease risk in the elderly: total cholesterol versus high-density lipoprotein-cholesterol.

Despite recent national recommendations to use total cholesterol (TC) measures to screen patients for hyperlipidemia and coronary heart disease (CHD) risk, it is unclear how predictive this approach is for older adults, who tend to have higher high-density lipoprotein-cholesterol (HDL-C) values and therefore higher TC. We looked at lipid profiles of 190 adults with a mean age of 70.8 years (range 51 to 86 years) to determine the value of TC in predicting risk states based on HDL-C. One hundred sixty-two did not have a diagnosis of CHD; 28 had a diagnosis of CHD. Of those subjects without CHD, 13 (8.0%) with a TC under 200 mg/dL were "underscreened" since they had a low HDL-C value under 40 mg/dL. Men were three times more likely to be underscreened on the basis of TC alone. Thirty (18.5%) of the subjects were "overscreened" since they had a TC greater than or equal to 240 mg/dL and a normal HDL-C value greater than 50 mg/dL. Only women were overscreened. For those 28 subjects with CHD, TC values alone also "underscreened" 3 (10.7%) of this cohort, and "overscreened" 3 (10.7%). If a provider decides to screen for hyperlipidemia and CHD risk in older patients, a lipid profile rather than a nonfasting TC test should be ordered. Over 26% of the patients in this study would have been misclassified and inappropriately advised regarding their risk for CHD based on a TC value alone.

Aged↗
PubMedDate not supplied

Career choices of general preventive medicine residency graduates: 1981-1986.

To identify career choices made by recent graduates of general preventive medicine residency programs, all funded residency programs in general preventive medicine (excluding federal and military programs) were surveyed. Eighty-two percent of programs responded and reported on the career choices of 241 graduates who graduated from 1981 to 1986. In order of preference, the categories of career choice were: program activities (36.5%), teaching (19.1%), clinical services (17.0%), and research (6.2%). About one-fifth (21.2%) chose other activities. The number of graduates more than doubled between the periods 1981-1983 and 1984-1986. There was a threefold increase in the percentage of graduates involved primarily in research; however, there was a 33% decrease in the percentage of graduates who became professional academicians.

Career Choice↗
PubMedDate not supplied

Strategies for integrating clinical preventive medicine into family medicine clerkships.

The value of integrating preventive medicine into primary care is widely accepted, although practical teaching methods to model this integration into medical student clerkships are not well developed. This paper reports on a competency-based clinical preventive medicine curriculum developed within an existing family medicine clinical clerkship. Evaluation of the curriculum during its first full year of implementation shows that students can significantly improve their perceived levels of competence in discussing specific healthy behaviors and risk factors as well as their fund of knowledge in preventive medicine content areas. However, the greatest effect of the curriculum was on increasing students' knowledge of basic health promotion concepts. Results from this clerkship suggest that collaborative efforts to integrate clinical preventive medicine into primary care education and to support the teaching of health promotion and disease prevention in clinical clerkships can be successful.

Age Factors↗
PubMedDate not supplied

The impact of lifestyle factors on serum 25-hydroxy vitamin D levels in older adults: a preliminary study.

We studied 49 adults between the ages of 60 and 91 to determine the impact of lifestyle factors on serum 25-hydroxy vitamin D levels. The subjects were interviewed to determine their sunscreen use, sun exposure, dietary and supplemental vitamin D intake, current medical problems, and medications used. Serum levels of 25-hydroxy vitamin D (D2 and D3) were measured. Forty-six percent of our subjects had a total vitamin D intake less than 400 IU/day and 49% never used sunscreen. Sunscreen use was positively correlated with 25-hydroxy vitamin D serum levels. Total vitamin D intake was more significant than sun exposure in determining 25-hydroxy vitamin D levels.

25-Hydroxyvitamin D 2↗