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PubMed1981

Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients.

This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs.

Attitude to Health↗

PubMed1989

Retinoic-acid-induced limb-reduction defects: perturbation of zones of programmed cell death as a pathogenetic mechanism.

Pregnant C57Bl/6J mice were treated with 100 mg/kg body weight of all-trans retinoic acid in sesame oil on day 11.0 of gestation. Among the live fetuses harvested on day 18 of gestation, 100% had mesomelic defects of the limbs as determined by gross examination and skeletal staining. Control fetuses treated with sesame oil had no observable limb malformations. Some treated and control embryos were harvested 12 hr after treatment and examined for patterns of cell death by using the supravital stain Nile blue sulphate and methylene-blue- and acid-fuchsin-stained histological sections. Retinoic-acid-induced cell death in the core of the limb was always associated with the zones of programmed cell death as seen in control embryos of comparable stages. This, in concert with previous studies demonstrating excessive cell death in regions of programmed cell death that correlated with subsequent malformations, leads us to conclude that the pathogenesis of mesomelic malformations has a primary association with the phenomenon of programmed cell death.

Abnormalities, Drug-Induced↗

PubMed1997

Dialysate sodium delivery can alter chronic blood pressure management.

Low dialysate sodium concentrations can reduce postdialysis thirst and serum sodium activity, but patients typically experience dialysis hypotension, fatigue, disequilibrium, and cramps. "High-sodium" hemodialysis minimizes dialysis disequilibrium but increases the serum sodium activity of most patients. Programmed "variable-sodium" dialysis can minimize dialysis discomfort but may also alter the sodium kinetics from those of "high-sodium" dialysis. We designed a cross-over study with random order assignment to determine whether a "variable-sodium" dialysis program could reduce the blood pressure of dialysis patients without increasing dialysis morbidity. Dialysis with a dialysate sodium of 140 mEq/L was compared with dialysis with a programmed exponential decrease of dialysate sodium from 155 mEq/L to 135 mEq/L. Dialysate sodium was then held constant at 135 mEq/L for the final half hour of dialysis. Eighteen patients completed the 7-month study, each receiving 3.5 months of experimental and 3.5 months of standard therapy. Programmed "variable-sodium" dialysis resulted in a reduction in antihypertensive drug use without alterations in predialysis blood pressure, interdialytic weight gain, ultrafiltration tolerance, or the frequency of symptomatic dialysis cramps or hypotension. Patients did, however, have lower postdialysis standing blood pressures and higher postdialysis target weights during programmed "variable-sodium" dialysis.

Adult↗

PubMed1995

Effects of chromium picolinate on body composition.

OBJECTIVE: This study explored the efficacy of chromium picolinate as a fat-reduction aid for obese individuals enrolled in a physical exercise program. EXPERIMENTAL DESIGN: The study employed a double-blind, placebo-controlled protocol and lasted for 16 weeks. SETTING: The physical conditioning programs were conducted on Navy bases (gymnasium, athletic field, etc.) and met a minimum of three times per week for at least 30 minutes of aerobic exercise. PARTICIPANTS: Participants were healthy, active-duty Navy personnel (79 men, 16 women) who exceeded the Navy's percent body fat standards of 22% fat for men, 30% for women. Mean age was 30.3 years; racial distribution was 76% white, 16% black, and 8% other. Comparisons between the 95 study completers and the 109 dropouts revealed no significant differences in demographics or baseline percent body fat. INTERVENTIONS: Bottles of capsules containing either 400 micrograms chromium picolinate or a placebo were distributed to the designated individuals by their fitness program coordinator. Participants took one capsule per day and kept a log of their daily exercise activities. They also completed a pre-post questionnaire concerning their health and lifestyle habits. MEASURES: Primary outcome measures were percent body fat, body weight, and lean body mass. Percent body fat was computed from body circumference measurements and height. Analyses controlled for diet and exercise. RESULTS: At the end of 16 weeks, the group as a whole had lost a small amount of weight and body fat. However, the chromium group failed to show a significantly greater reduction in either percent body fat or body weight, or a greater increase in lean body mass, than did the placebo group. CONCLUSIONS: It was concluded that chromium picolinate was ineffective in enhancing body fat reduction in this group and could not be recommended as an adjuvant to Navy weight-loss programs in general.

Adult↗

PubMed1990

Long-term exercise training with constant energy intake. 2: Effect on glucose metabolism and resting energy expenditure.

The effect of exercise training on glucose and insulin metabolism as well as on resting energy expenditure was investigated in five young men (mean BMI = 27.5 +/- 2.9 (s.d)). Subjects performed cycle-ergometer exercise 6 days/week over a 100 day period and the quantity of daily exercise was calculated to induce a 4.2 MJ/day surplus in energy expenditure during the days of training. As expected, significant weight and fat losses were observed in response to the training program. Exercise training induced a significant reduction in fasting levels and in the responses of insulin to a 4.2 MJ meal or an oral glucose load. Most of the training effects were noted after only 25 days of training. However, a significant decrease in plasma C-peptide concentrations during the oral glucose tolerance test was observed only at the end of the exercise program whereas essentially no change occurred during the first 25 days of training. The resting metabolic rate (RMR) and the thermic effect of food (TEF) were not significantly modified by training. Results show that the reduction in plasma insulin induced by training occurred earlier than that for C-peptide. Moreover, the absence of change in RMR in the presence of a substantial weight loss may represent a beneficial effect of training in comparison to the documented effect of diet-induced weight loss on RMR.

Adult↗

PubMed1999

Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care.

OBJECTIVES: (1) To evaluate the evidence relating to the effectiveness of methods to prevent and treat obesity, and (2) to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years and for the measurement of the body mass index (BMI) as part of a periodic health examination. OPTIONS: In adults with obesity (BMI greater than 27) management options include weight reduction, prevention of further weight gain or no intervention. OUTCOMES: The long-term (more than 2 years) effectiveness of (a) methods to prevent obesity and (b) methods to treat obesity. EVIDENCE: MEDLINE was searched for articles published from 1966 to April 1998 that related to the prevention and treatment of obesity; additional articles were identified from the bibliographies of review articles and the listings of Current Contents. Selection criteria were used to limit the analysis to prospective studies with at least 2 years' follow-up. BENEFITS, HARM AND COSTS: Health benefits of weight reduction were evaluated in terms of alleviation of symptoms, improved management of obesity-related diseases and a reduction in major clinical outcomes. The health risk of weight-reduction methods were briefly evaluated in terms of increased mortality and morbidity. VALUES: The recommendations of this report reflect the commitment of the Canadian Task Force on Preventive Health Care to provide a structured, evidence-based appraisal of whether a manoeuvre should be part of a periodic health examination. RECOMMENDATIONS: (1) PREVENTION: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs; however, because of considerable health risks associated with obesity and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers (grade C recommendation). (2) TREATMENT: (a) For obese adults without obesity-related diseases, there is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods (grade C recommendation); (b) for obese adults with obesity-related diseases (e.g., diabetes mellitus, hypertension), weight reduction is recommended because it can alleviate symptoms and reduce drug therapy requirements, at least in the short term (grade B recommendation). (3) Detection: (a) for people without obesity-related diseases, there is insufficient evidence to recommend the inclusion or exclusion of BMI measurement as part of a periodic health examination, and therefore BMI measurement is left to the discretion of individual health care providers (grade C recommendation); (b) for people with obesity-related diseases, BMI measurement is recommended because weight reduction should be considered with a BMI of more than 27 (grade B recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Adolescent↗

PubMedDate not supplied

African Americans and obesity: implications for clinical nurse specialist practice.

PURPOSE/OBJECTIVE: The purpose of this article is to examine the connection between genes, culture, and environment in the development of obesity and its impact on the health of African Americans. This information will be utilized to facilitate the design of weight management programs for African Americans. RATIONALE: Literature review of the connection between the above variables revealed a disproportionate amount of health risks associated with excess weight in African Americans. Several nonfatal consequences of obesity were noted to impact quality of life but improved significantly with small reductions in body weight. However, factors that affect weight in a culturally relevant context were seldom addressed and few intervention programs were specifically designed to treat minorities with obesity issues. DESCRIPTION: This article describes the role that genetic, cultural, and environmental factors play in energy regulation. Factors that impact lifestyle changes, self-esteem, public awareness, participation, and community involvement are highlighted. OUTCOME: Providing healing environments that are culturally acceptable can empower individuals to commit to goals as well as influence others who are resistant to change. Public awareness tools designed by clinical nurse specialists (CNSs) that appeal to ethnic values can facilitate cooperation and enhance successful outcomes. CONCLUSION: Despite genetic susceptibility to obesity, research on the African diaspora emphasized that obesity tends to be expressed in environmental conditions that are markedly different from ancestral origin. (Kruger A, Kruger HS, MacIntyre U, et al. S Afr J Sci. 2000;96:505-513. Available at: www.nrf.ac.za/sajs/absepooj.stm. Accessed April 11, 2004.) Black adults therefore have much to gain from weight management strategies that address the complexity of the disorder and are sensitive to cultural issues. IMPLICATIONS FOR NURSING PRACTICE: CNSs with advanced knowledge of the impact of obesity on health and wellness are in a unique position to utilize research-based data in the design of weight management programs for diverse populations. In practice, cultural variables that significantly impact the complex issues of weight control should be addressed in the study and treatment of obesity in black populations. By researching what is available to the community, CNSs can evaluate programs that may require adaptation to encourage greater participation.

Black or African American↗

PubMed2000

Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific people living in New Zealand.

OBJECTIVES: The aim of this study was to compare perceptions of body size in European, Maori and Pacific Islands people with measured body mass index (BMI), waist-to-hip ratio and change in BMI since age 21 y. Socio-demographic factors that influenced perceptions of body size were also investigated. DESIGN: Cross-sectional survey. METHODS: Participants were 5554 workers, aged > or =40 y, recruited from companies in New Zealand during 1988-1990. RESULTS: Prevalences of BMI>25 kg/m2 were: Europeans, 64.7% men, 47.2% women; Maori, 93.2% men, 80.6% women; and Pacific Islanders, 94.1% men, 92.9% women. Similarly, prevalences of BMI >30 kg/m2 were: Europeans, 14.4% men, 14.6% women; Maori, 55.0% men, 41.9% women; and Pacific Islanders, 55.1% men, 71.7% women. At each perception of body size category, Maori and Pacific Islands men and women had a higher BMI than European men and women, respectively. BMI increased with increasing perception of body size in all gender and ethnic groups. Since age 21, increases in BMI were highest in Pacific Islands people and increased with increasing perceptions of body size category in all ethnic and gender groups. BMI adjusted odds (95% CI) of being in a lower perception category for body size were 1.70 (1.38-2.12) in Maori and 8.99 (7.30-11.09) in Pacific people compared to Europeans, 1.27 (1.13-1.42) times higher for people with no tertiary education, 1.41 (1.25-1.59) times higher in people with low socioeconomic status, and 0.94 (0.92- 0.95) for change in BMI since age 21. CONCLUSION: Nutritional programs aimed at reducing levels of obesity should be ethnic-specific, addressing food and health in the context of their culture, and also take into account the socioeconomic status of the group. On the population level, obesity reduction programs may be more beneficial if they are aimed at the maintenance of weight at age 21.

Adult↗

PubMed1997

Brief description of the Multiple Risk Factor Intervention Trial.

The Multiple Risk Factor Intervention Trial (MRFIT) was one of the coronary heart disease prevention trials recommended to the National Heart and Lung Institute in 1971 as an alternative to a national single-factor dietary trial, which was judged to be infeasible. MRFIT was a randomized, primary prevention trial, conducted at 22 US clinical centers from 1973 to 1982 to test whether lowering elevated serum cholesterol and diastolic blood pressure and ceasing cigarette smoking would reduce coronary heart disease mortality. Men 35-57 y of age (n = 12,866) with one or more of these risk factors were randomly assigned to the special intervention (SI) or usual care (UC) group and followed for 6-8 y. UC men were given information on risk factors, referred to their usual sources of care, and reexamined annually. SI participants received group and individual counseling on a fat-modified diet, a stepped-care drug treatment program for diastolic hypertension (after an initial attempt at blood pressure control by weight reduction, if indicated), and, for cigarette smokers, counseling aimed at cessation. SI men had risk factor assessments every 4 mo and annual examinations that were generally identical to those given to UC men and that always included measurement of blood cholesterol concentration. A listing of variables measured at each visit along with the design and major mortality results of MRFIT are included in this chapter.

Adult↗

PubMed2004

Health programs in faith-based organizations: are they effective?

OBJECTIVES: We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs. METHODS: We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28). RESULTS: Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination. CONCLUSIONS: Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated.

Health Promotion↗

PubMed1982

Physiological observations in essential hypertension.

The various mechanisms that may be involved in essential hypertension are discussed, as well as their therapeutic implications. A step-care treatment program has been shown to be effective not only for the treatment of the individual patient with mild hypertension but also in mass population treatment programs. It is based on a program of sound general medical care, including dietary sodium restriction, reduction of excess body weight, and pharmacologic therapy. With intelligent use of anti-hypertensive drugs for effective control of arterial pressure, a drastic reduction in cardiovascular morbidity and mortality can be expected.

Coronary Disease↗

PubMed1996

Clearance of phenytoin and valproic acid is affected by a small body weight reduction in an epileptic obese patient: a case study.

The interaction between clearance of phenytoin, valproic acid, phenobarbital and carbamazepine, and changes in body weight was determined in a 19-year-old obese woman with epilepsy (body weight 93 kg, BMI 36.3 kg/m2). The patient, who was given daily oral doses of 100 mg phenobarbital, 350 mg phenytoin, 800 mg valproic acid and 800 mg carbamazepine over 5 months was hospitalized for obesity treatment. The daily dosage of each drug was held constant during treatment of the obesity. Blood samples were taken five times. Weight reduction was 7 kg (7.5%) over 46 days. Estimation of the pharmacokinetic parameters in each drug was performed by Higuchi's Bayesian program, PEDA Pearson's correlation coefficient (r) between clearance and body weight was calculated for each drug. High positive correlations were found between clearance and body weight for phenytoin (r = 0.800) and valproic acid (r = 0.785), but not for phenobarbital (r = -0.227) and carbamazepine (r = 0.152). Clearance of phenytoin and valproic acid may be potentially affected by small changes in body weight.

Adult↗

PubMed2005

[Public health measures studied in order to reduce antenatal exposure to tobacco: review of literature].

INTRODUCTION: One of the questions raised by the Consensus conference "Pregnancy and Tobacco" conducted in October 2004 in France concerned the public health measures which should be studied to reduce antenatal exposure to tobacco. METHODS: We conducted a review of the literature on the following topics: smoking cessation interventions, smoking cessation biochemical validation, role of health professionals in smoking cessation and financial coverage of smoking cessation programs for pregnant women. RESULTS: Smoking cessation interventions during pregnancy lead to a lower rate of low birth weight, a reduction of preterm births and an increase in average birth weight. Biochemical validation of smoking cessation is necessary for both scientific and educational purposes. The role of health professionals in smoking cessation has been proved to be effective. CONCLUSION: Implementation of smoking cessation programs tailored for pregnant women is necessary in France, after appropriate training of health professionals. A study should be set up to test the efficacy of Nicotine Replacement Therapy (NRT) on smoking cessation during pregnancy.

Female↗

PubMed1990

Treatment of obesity.

Decreases in resting metabolic rate and thermic effect of exercise during and after caloric restriction contribute to a reduced rate of weight reduction and subsequent difficulty in weight maintenance. Increasing exercise increases the thermic effect of exercise and prevents a decrease in resting metabolic rate, thereby, improving the rate of weight loss. A combined program of caloric restriction, exercise, and behavior therapy (including relapse prevention training and social support systems) is the most successful approach to long term weight reduction efforts. Pharmacologic treatment is currently limited, but there are three areas of development: agents which reduce energy intake, inhibitors of lipid synthesis, and thermogenesis enhancers. Evidence for improving efficiency of weight loss prevention and prevention of weight regain during repeated cycles of dieting (yo-yo phenomenon) exists in rat studies but not in a preliminary human investigation.

Basal Metabolism↗

PubMed1987

Weight reduction for control of systemic hypertension.

It has been well documented that antihypertensive treatment can prolong life and decrease cardiovascular disease in patients with hypertension. Weight reduction is an effective means of decreasing blood pressure. We have treated normal-weight to obese hypertensive patients with weight reduction as a nondrug means of controlling mild to moderate hypertension. Adjunctive therapy included reduced sodium intake (initially 1 g of sodium daily, increased to 2 to 5 g daily), increased physical activity and relaxation techniques. Of the 130 protocol patients, 68 (52%) were normotensive while not taking any medication at the end of the program. Additionally, 36 patients (28%) had lower blood pressure, needed less medication or both; 26 patients (20%) did not have a positive response. Weight reduction is a useful method to control hypertension and a reasonable alternative to drug therapy.

Adult↗

PubMed2001

Differences in mechanisms between weight loss-sensitive and -resistant blood pressure reduction in obese subjects.

This study was conducted to clarify the mechanisms involved in the sensitivity for blood pressure (BP) reduction in response to weight loss. In particular, we focused on the contributions of sympathetic nervous system activity and fasting plasma leptin and insulin levels to BP levels during weight loss in obese subjects with weight loss-sensitive and -resistant BP reduction. Sixty-one young, obese untreated hypertensive men (HT) and 52 obese normotensive men (NT) were enrolled in a weight loss program consisting of a low caloric diet and aerobic exercise over a 24-week period. At entry and at week 24, body mass index (BMI), BP, plasma norepinephrine (NE), leptin and insulin were measured. Successful weight loss and BP reduction were respectively defined as a more than a 10% reduction in BMI or mean BP from baseline at week 24. More than 60% of subjects in either group successfully achieved weight loss by this definition. The percentage of subjects who successfully achieved BP reduction was higher (64%) among those subjects who achieved weight loss than among those who did not (22%). Plasma NE level at entry in subjects who failed to achieve BP reduction despite weight loss was significantly higher than that in subjects who succeeded in BP reduction. Plasma leptin and insulin levels were similar between subjects with and without BP reduction. In addition, the absolute decrement and percent decrement in plasma NE in subjects who succeeded in BP reduction were significantly greater than those in subjects who failed to reduce their BP. Absolute and percent decrements in plasma leptin and insulin were similar in both groups. These results suggest that individuals who are resistant to weight loss-induced BP reduction have more sympathetic overactivity both at the outset of and during weight loss.

Adult↗

PubMed2004

Why All the Fuss About Portion Size?: Designing the New American Plate.

In attempting to respond to current public concerns about nutrition when creating its health education program, the New American Plate, the American Institute for Cancer Research found it necessary to emphasize the importance of portion size. Justifiable concern about overweight and obesity and as yet unproved ideas about weight management were causing people to distort the shape of their diet. The focus of the new education program was reduction of cancer risk through a predominantly plant-based diet. To ensure a cancer-protective proportion of plant food to animal food, the American Institute for Cancer Research had to expound gradual reduction of portion size, accompanied by increased exercise as the primary means of weight management.

Journal Article↗

PubMed1993

The visual field indices in primary open-angle glaucoma.

PURPOSE: The distribution of sensitivity across the visual field, as determined by automated threshold static perimetry, can be summarized in terms of visual field indices. Such indices can be weighted for the variation in threshold at each eccentricity. The aims of this study were to determine the influence of the weighting factor, the relationship between the unweighted indices derived from Programs 30-2 and 24-2, and the relationship between the number of double determinations of threshold and the magnitude of the short-term fluctuation. METHODS: One visual field derived by Program 30-2 of the Humphrey Field Analyzer was selected from each of 60 consecutive patients with primary open-angle glaucoma. The first two fields from each individual patient were avoided. Unweighted visual field indices were calculated and compared with the Program 30-2 weighted indices using an assessment of agreement evaluated with respect to the 95% confidence limits of the population. RESULTS: The weighting function had no influence on the mean deviation, but it caused a slight reduction in the short-term fluctuation and an elevation in the pattern and corrected pattern standard deviations. There was little difference between the indices generated by Programs 30-2 and 24-2. The short-term fluctuation increased with an increase in the number of double determinations of threshold. CONCLUSIONS: The weighting function had little clinical influence on the visual field indices. The indices derived from Programs 30-2 and 24-2 were similar, and the short-term fluctuation would better reflect the intratest variability if all available double determinations of threshold were used to calculate the index.

Aged↗