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Results for “Self-selection”

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PubMed1991

A clinical trial of the American Heart Association step one diet for treatment of hypercholesterolemia.

BACKGROUND: Although diet therapy is the primary treatment for hypercholesterolemia, a trial to determine the effectiveness of the new American Heart Association Step One Diet (AHA diet) in lowering cholesterol has to our knowledge never been carried out. METHODS: A clinical trial was conducted to assess the plasma lipids response and adherence to the AHA diet in 120 men and women with hypercholesterolemia. All subjects were advised to follow the AHA diet for 18 weeks. RESULTS: After 6 weeks of the AHA diet intervention, there were modest but significant reductions in plasma total cholesterol (-2.6%) and low-density lipoprotein (LDL) cholesterol (-3.5%), but no further significant reductions were observed thereafter. Rather, there was a tendency to return to and even exceed baseline levels of total cholesterol and LDL cholesterol over the subsequent 12 weeks, in spite of the subjects' reported continued adherence to the AHA diet and maintenance of weight loss throughout the entire study period. Nevertheless, 51% of the subjects had experienced improvement (-0.2% to -26.3%) in their plasma LDL cholesterol levels by the end of the study. CONCLUSIONS: A probable reason for the limited response of the diet was low baseline levels in intake of saturated fat and cholesterol by participants. The subjects who were older and had higher levels of plasma LDL cholesterol and total fat intake at baseline experienced better plasma LDL cholesterol response to the AHA diet. Thus, practicing physicians should consider assessing the baseline dietary fat and cholesterol intake of patients with hypercholesterolemia before starting the AHA diet, since patients may already be following a relatively prudent self-selected diet. Additional dietary gains in lipid management might well require a more severe restriction of dietary fats and cholesterol. Long-term efficacy of the AHA diet should also be evaluated clinically with periodic lipid profiles.

Adult↗

PubMed1991

The interrelation of urinary calcium and sodium intake in healthy elderly Japanese.

To evaluate whether habitual excess sodium intake is significant as a risk factor for calcium loss in elderly Japanese, a relationship between calcium excretion and sodium excretion was studied in 39 male and 44 female Japanese, aged 60 and over. They are healthy, free-living and consuming a self-selected diet. A significant positive correlation between urinary calcium excretion and sodium excretion per 24-hour was observed both in males (r = .415, p less than 0.01) and in females (r = .330, p less than 0.05). The relationship was still significant even after adjustment for sex, age, body mass index, alkaline phosphatase levels and protein as well as calcium and phosphorus intake. It was estimated that the increase in urinary calcium excretion was about 1.0 mmol/day per 100 mmol increase in urinary sodium excretion.

Aged↗

PubMedDate not supplied

The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents.

We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.

Adolescent↗

PubMed1991

[Cardiovascular risk factors of visitors to a mass-screening booth].

The attitude towards mass screening of serum cholesterol is controversial. In order to characterize the volunteers of such screenings and to test the representativity of its findings, we compared the data of 1686 adult health-screening participants collected during a trade fair in the city of Basel, Switzerland, with the results of two population-based studies, the Basel City Risk Factor Survey and the MONICA Project in Western Switzerland. Among those screened, there was an over-representation of women and older persons. The age-specific medians of blood cholesterol and proportions of hypercholesterolemic persons were consistently higher in female screenees--and marginally so in males--than in the reference populations, whereas higher proportions of persons with ideal cholesterol level in those screened were also observed, especially in younger males. Higher systolic blood pressure, lower relative body weight and less regular smoking were found consistently among the screenees. This cross-sectional study shows that the participants of such mass screening actions are a selective group of older, more frequently female health-conscious persons with a specific risk-factor pattern. Mass screenings of self-selected volunteers can, therefore, not be used for a reliable prediction of risk-factor distributions in the general population. Moreover, suggested further steps for those screenees with both health-conscious behavior and elevated biological risk-factor levels, such as second measurement, medical consultation and counselling, cannot be assured in the setting of a trade fair. The objectives and intentions of such mass screening activities should be reconsidered and discussed.

Adult↗

PubMed1991

An American clinic for traditional Chinese medicine: comparisons to family medicine and chiropractic.

Patient self-selection delimits the kinds of disorders treated by practitioners of acupuncture and other traditional Chinese modalities in the United States. Based upon a questionnaire administered to 200 first-time patients in a teaching clinic for traditional Chinese medicine (TCM) in California, it was determined that practitioners of TCM attract patients whose health problems would also be appropriate for management by family physicians, chiropractors or mental health professionals. Approximately one-third of presenting complaints can be categorized as presumed organic disorders (many of which may have been medical treatment failures); one-third comprise musculoskeletal problems and headaches; and one-third appear to be psychological or psychosomatic in nature.

Acupuncture Therapy↗

PubMed1991

Medical audit: a Well Woman Clinic in the Royal Naval training practice, Gibraltar.

In order to assess the effectiveness of patient self-selection, and the value of dedicating surgery time to a specific clinic, attendances at a Well Woman Clinic were compared with attendances for the same reasons at other times. During the nine month audit period the opportunity was also taken to overhaul the Age/Sex Register, and assess the uptake of Cervical Screening at the Garrison Medical Centre. This unit is part of the Royal Naval Training Practice in Gibraltar.

Ambulatory Care Facilities↗

PubMed1991

The substance-abusing family: consideration for nursing research.

Investigations to explore and document the characteristics of addicted families are possible for nurse researchers in a variety of settings. Addicted families can be identified through hospitals, clinics, or community substance abuse treatment centers. Confidentiality issues must be addressed with carefully designed consent forms. A thorough understanding of addicted family systems is essential. System, role, and family theories provide a framework for understanding the influence of substance abuse on all family members. Anticipation of common social, economic, and criminal crises of addicted families will assist the researcher to avoid conflicts between research and service. Methodological limitations are common in research with addicted families, but well-designed, descriptive studies with small- to moderate-sized self-selected samples can add greatly to our nursing knowledge base over time.

Confidentiality↗

PubMed1991

Work and power in gait of stroke patients.

Biomechanical analysis of the work and power patterns involved in gait provides insight into the nature of gait deficits and suggests methods for improvement. The purpose of this study was to describe the work and power characteristics during gait for both limbs of hemiplegic patients, and to determine the work and power variables related to self-selected speeds of walking. The gait of 30 ambulatory adults between the ages of 47 and 79 years was studied using two-dimensional cinematography and force-plate data in a link-segment model. About 40% of the positive work required for walking was performed by the muscles of the affected side. Major contributors were the ankle plantar flexors, hip flexors, and hip extensors. The results suggest interdependence between the limbs and between muscle groups of the same limb; a need for further research is indicated.

Aged↗

PubMed1991

Idiopathic gastroparesis is associated with a multiplicity of severe dietary deficiencies.

UNLABELLED: Idiopathic gastroparesis (IG), a disorder characterized by abnormally delayed emptying of food from the stomach, is associated with many symptoms that could have an impact on dietary intake. The intake of dietary protein, carbohydrate, fat, fiber, vitamins, and minerals was prospectively evaluated in patients with symptomatic IG and compared with asymptomatic controls. Twenty-four patients and 24 age- and sex-matched controls completed a detailed 7-day diet record while consuming a self-selected diet. Dietary information was entered into a computer and analyzed using the Nutranal program. Results were expressed as daily intake and percent recommended dietary allowance (%RDA) when applicable. Patients consumed a diet containing fewer calories than would have been predicted based on age, height, sex, frame, and weight (85% of calculated energy expenditure vs 100%) for controls. Although patients with IG consumed significantly fewer calories than controls (1112 kcal vs 1431 kcal), the proportion of fat (32% vs 34%), carbohydrate (49% vs 48%), and protein (17% vs 16%) was similar in the two groups. Intake of vitamins B6, vitamin C, folate, niacin, riboflavin, thiamine, calcium, copper, iron, magnesium, phosphorus, and zinc were below the %RDA. Intake of vitamin B12, vitamin C, folate, thiamine, niacin, magnesium, phosphorus, and zinc were significantly less than controls. Vitamin A intake was above the RDA and not different from that of controls. Prolonged t1/2 of solids correlated with diminished intake of protein, iron, niacin, and potassium. They correlated inversely with serum albumin in patients with idiopathic gastroparesis. CONCLUSION: Although eating less, patients with IG do not consistently alter the proportion of fat, carbohydrate, and protein in their diets. Because their diet is markedly deficient in a number of essential vitamins and minerals, dietary evaluation and counseling is suggested for all patients with idiopathic gastroparesis.

Adult↗

PubMed1991

Relationships of anxiety scores to screening and training status of air traffic controllers.

The present study assessed the relationship between anxiety, as measured by the State-Trait Personality Inventory (STPI), and success of post-strike air traffic control specialist (ATCS) trainees at the FAA Academy and during field training. The STPI was administered to students who entered the FAA Academy between June 1984 and September 1985. Academy test scores were obtained for 1,790 students in the en route option. Criterion data included the field training status of the Academy graduates as of July 1988. Statistical analyses determined the relationships between ATCS student scores on the STPI measures and a) normative data and b) Academy screening and field training results. ATCS students reported significantly lower state (current level) and trait (proneness) levels of anxiety than did either college students or military recruits. Trainees who had relatively high scores (for ATCSs) on a combined index of the trait and state measures of anxiety exhibited significantly higher a) percentages of Academy failures/withdrawals, b) percentages of option switches in the field, and c) overall field attrition, than did trainees with low scores. Results support the operation of some personality-related self-selection among ATCS applicants regarding anxiety and the importance of this low anxiety characteristic for ATCS job success.

Aerospace Medicine↗

PubMed1991

Segmental contributions to total body momentum in sit-to-stand.

In a previous investigation, we reported that the maximum linear momentum of the body center of mass (CM) during a sit-to-stand task showed a relative invariance in the horizontal vs the vertical direction of motion as the speed of ascent increased from natural to fast. The present study investigated the segmental origin of this directionally specific difference by examining the linear momentum of the shank, thigh, and head-arm-trunk segments for ten healthy young adults at slow, natural, and fast self-selected speeds. Findings indicated that the head-arm-trunk was the major contributor to the horizontal maximum linear momentum of the CM and accounted for the relative invariance in its magnitude. In contrast, the thigh was the major contributor to the vertical maximum linear momentum of the CM and was responsible for the progressive increase in its magnitude across the range of speeds. Moreover, the compatibility between the motions of the head-arm-trunk and of the shank in their general profile and peak magnitudes further suggested that a simplifying strategy may have been employed to reduce the overall number of degrees of freedom associated with the sit-to-stand movement.

Adult↗

PubMed1990

An assessment of the level of dental and mouthcare knowledge amongst nurses working with elderly patients.

A 60 item questionnaire was completed by a self-selected sample of nurses working with elderly patients. The questionnaire was divided into three sections; to collect personal data, to assess the nurses' attitude to mouthcare and their level of training in this subject, and to assess the level of dental knowledge. This paper identifies the disadvantages of using a self selected as opposed to a random sample. Analysis of the completed questionnaires revealed a fairly high level of basic training in dental and mouthcare matters. There was however, a paucity of specific dental knowledge e.g. there was some confusion over the aetiology and prevention of dental caries and also as to the difference between gingivitis and periodontitis. In addition, few nurses seemed to be aware of the effects systemic disease and drugs may have on the oral tissues. In spite of this most respondents achieved more than 50 per cent correct answers. A number of recommendations to improve nurses' dental knowledge is given at the end of the article.

Aged↗

PubMedDate not supplied

Determining HIV seroprevalence among women in women's health clinics.

Human immunodeficiency virus, type 1 (HIV), seroprevalence studies are needed to determine the level and trends of HIV infection among women attending family planning, abortion, and prenatal care clinics in the United States. A review of published and unpublished studies showed that HIV seroprevalence among women attending women's health clinics was 0 to 2.6 percent, although the studies were difficult to compare because of differences in methodology. The Centers for Disease Control, in association with State and local health departments, has developed a standardized protocol to determine HIV seroprevalence among women attending women's health clinics in selected metropolitan areas. Blinded HIV serosurveys (serologic test results not identified with a person) are being conducted annually in selected sentinel clinics in order to obtain estimates of HIV seroprevalence unbiased by self-selection, as well as to monitor trends in infection among clients attending these clinics. In areas with high HIV seroprevalence, nonblinded serosurveys (in which clients voluntarily agree to participate) will be used to assess behaviors that may place women at increased risk of exposure to HIV. Data from the surveys can be used in developing age-specific and culturally appropriate AIDS educational materials, assessing the amount and type of counseling activities required, and evaluating acquired immunodeficiency syndrome (AIDS) prevention activities. The information will provide epidemiologic data to complement the results of other surveys in characterizing the scope of HIV infection among women of childbearing age in the United States.

AIDS Serodiagnosis↗

PubMedDate not supplied

Using seroprevalence data in managing public health programs.

An objective of the Centers for Disease Control (CDC) family of HIV seroprevalence surveys, conducted by State and local health departments, is the collection of seroprevalence data that may be useful in managing public health programs. In prevention programs, seroprevalence data may be used in allocating resources, in determining the types and amount of education, counseling, and testing services offered, and in identifying access points for HIV-infected persons for medical followup and care. Over time, data will be useful in detecting and following trends in HIV infection and in evaluating the impact of program activities to prevent HIV infection. No single seroprevalence survey is representative of the entire population of a metropolitan area. Each type of survey has strengths and limitations that must be considered when interpreting seroprevalence data. However, results from the family of surveys are the best available data because they are relatively unaffected by self-selection bias, they are standardized, and the information is collected over time. Characterization of the population surveyed and adherence to standard CDC protocols improve the quality of the data. Consultants in health departments and at CDC form a network for providing technical support and disseminating data to health care providers and program managers.

AIDS Serodiagnosis↗

PubMed1990

Intake of essential and toxic trace elements in a random sample of Danish men as determined by the duplicate portion sampling technique.

Average daily intakes of essential and toxic trace elements from self-selected diets consumed by 100 men, selected as a random sample among the population of 30-34 year-old men in one urban and two rural areas of Denmark, were determined by the analysis of 48 h duplicate food portions. Median daily dietary intakes were 11.3 mg for zinc, 1.1 mg for copper, 11.3 mg for iron, 51 micrograms for selenium, 3.9 mg for manganese, 99 micrograms for molybdenum, 7 micrograms for lead and 11 micrograms for cadmium. Median dietary intake of mercury was below the detection limit. The observed nitrogen, sodium and potassium intakes were about 25% lower than the average total daily excretion of these constituents. It is therefore assumed that dietary intakes of nutrients during the duplicate portion sampling period were reduced by about 25% and that the observed intakes of trace elements can be regarded as minimum estimates of habitual intake. Taking this into consideration, it is concluded that the content of essential trace elements in Danish diets seems to be adequate and the amounts of the elements lead, mercury and cadmium are of little concern as regards health aspects.

Adult↗

PubMed1978

Update of naltrexone treatment.

To summarize, then, our work with naltrexone in a multi-modality treatment program indicates that it appeals to about 5-10 percent of narcotic addicts--those who conciously want to obtain drug-free status. It does significantly attentuate the effect of narcotics to the extent that they lose their reinforcing properties, and it has minimal side effects. Although we treated a self-selected population, it is noteworthy that about 10 percent of those who remained on naltrexone for more than a week were still opiate free 6 months after cessation of treatment. For some it appeared to be a turning point in their lives. It was the first time in years that they could live in their neighborhood and not be either intoxicated or occupied with the pursuit of narcotics. Our behavioral studies have identified a number of conditioned psychophysiological responses associated with the self-injection ritual. So far, although we have succeeded in extinguishing some of these responses, this has not resulted in an improved clinical outcome. We are currently working on more comprehensive behavioral treatments, but the clinical significance of these conditioned responses is uncertain at present.

Adult↗

PubMed1990

Sensitivity of the appetite control system in obese subjects to nutritional and serotoninergic challenges.

The sensitivity of the appetite system of a group of obese individuals was assessed in response to two challenges known to reduce hunger and enhance satiety in lean people. The challenges were the presentation of a caloric (high protein) load and the activation of serotonin systems. Eight obese female adults (BMI = 38) received 2 X 15 mg d-fenfluramine or placebo daily for 3 days, the study conforming to a 2 X 2 factor (drug X lunch type), double blind, repeated measures design. Three hours after dosing on day 3 they ate either a high carbohydrate (63 percent of total energy) or high protein (54 percent) lunchtime meal (the caloric load). These fixed meal challenges were equal in energy (475 kcal), weight and fat content. Ratings of hunger motivation and food preferences were tracked over the course of lunch and for a further 3 hours, at which point subjects returned for a self-selection test meal. Intakes from this second open meal revealed significant main effects of both caloric load and drug on energy intake, with the high protein d-fenfluramine combination being the most potent anorectic pairing. These findings were supported by the profiles of hunger motivation. This study has confirmed that the appetite system of these subjects was responsive to these biologically relevant challenges. The results suggest that the combination of an appetite modulating drug with specific dietary intervention may represent an effective strategy for the management of hunger arising from caloric restriction.

Adult↗

PubMed1990

Prevalence of anisometropia in volunteer laboratory and school screening populations.

For 10 years our laboratory has conducted, a longitudinal study of focusing and motor behavior of a volunteer population of 686 subjects aged 3 months to 9 years. Its purpose is to characterize normal refractive development in infants and children and to relate refractive anomalies to subsequent visual problems. Using age-related criteria for anisometropia adjusted to detect the most unusual 5% of the refractions on a test battery, we have found 19 nonstrabismic, anisometropic subjects (2.8% of total subject population). Of these, eight were either seen once or their anisometropia appeared at their last visit. Of the remaining 11 subjects, all had a reduction of their anisometropia to within normal limits on subsequent visits. Thus our current best estimate of persistent infant anisometropia is 0%, a startling result. By comparison, we found ten strabismic subjects (1.46%), two of whom had persistent anisometropia. Although we did not believe that anisometropic subjects could self-select and not participate in the study, it was possible that the volunteer laboratory population had characteristics atypical of the county at large. Thus we conducted a screening of 374 Head Start and first-grade pupils throughout the county, using the same methods. We found virtually no difference in the average refractive conditions between the laboratory and school populations and no significant difference in the prevalence of visual disorders. The very low prevalence of anisometropia in infants and young children in both populations has important implications for the etiology of anisometropic amblyopia.

Anisometropia↗