PubMed · 1073730
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A Ehrlich. 1976. Beyond behavioral objectives.. https://pubmed.ncbi.nlm.nih.gov/1073730/
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More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most common cause of death. For the cohort of Americans born in 2000, the estimated lifetime risk for diabetes is more than 1 in 3. In the next 50 years, the number of diagnosed cases of diabetes is predicted to increase by 165% in the United States, with the largest relative increases seen among African Americans, American Indians, Alaska Natives, Asian and Pacific Islanders, and Hispanic/Latino persons. Compelling scientific evidence indicates that lifestyle change prevents or delays the occurrence of type 2 diabetes in high-risk groups. This body of evidence from randomized, controlled trials conducted in 3 countries has definitively established that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. The number of persons at high risk for type 2 diabetes is similar to the number of persons who have diabetes. This paper summarizes scientific evidence supporting lifestyle intervention to prevent type 2 diabetes and discusses major policy challenges to broad implementation of lifestyle intervention in the health system.
In a 5.1-year-old girl who had been treated by surgical correction of biliary atresia and total orthotopic liver transplantation, extreme dietary selectivity was noted; this was treated by behaviour therapy. On entry in the rehabilitation centre, she manifested malnutrition along with a variety of gastro-enterologic complaints. The treatment consisted of a set of behavioural procedures such as stepwise expansion of the diet, verbal prompting, intermittent contingent attention and a list of agreements with a system of rewards; this led to the elimination of the dietary selectivity and to the consumption of a varied diet in a normal tempo.
RATIONALE: Behavioral and functional neuroimaging research has extensively documented the ways in which people with schizophrenia perform poorly on cognitive tasks and exhibit abnormal brain activity patterns when engaged in those tasks, even when their performance is adjusted to become similar to that of healthy controls. There is, however, substantial diversity in the way this syndrome limits a person's ability to learn and acquire skills. This review considers how functional imaging has helped improve our understanding of learning, practice, and error detection in persons with schizophrenia. OBJECTIVES: Positron Emission Tomography and functional magnetic resonance studies are reviewed with particular attention to the roles of these methods and interventions in understanding the biological substrates of cognitive dysfunction in schizophrenic patients. This is done with particular attention to the question of how brain regions change in response to motor, perceptual, and cognitive training interventions. RESULTS: Investigators agree that the prefrontal cortex, anterior cingulate cortex, and hippocampus are impaired in most persons with schizophrenia. Imaging studies with healthy controls support multiple models of biological change elicited by learning and practice. Application of these methods to patients with schizophrenia is in an early stage. CONCLUSIONS: A person's response to perceptual, motor, and cognitive training may help pharmacologists and clinicians better interpret medication treatment studies in this diverse population.