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Results for “Life Style--changes”

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PubMed1979

Prevention: rhetoric and reality.

No single strategy is capable of preventing untimely deaths and disabilities. In the United States in particular, the contribution of medical care is limited by inadequate provision of services (particularly to the poor), inappropriate training of physicians, and unnecessary costs. Lack of knowledge about disease universally limits medicine's effectiveness. Among nonmedical strategies, campaigns for life-style change are most likely to succeed in those with the lightest burden of illness. Efforts to increase individual responsibility might well reduce health expenditures, but at the same time the disparity in health between rich and poor will increase. Restrictions on the use of harmful substances and on the manufacture of toxic or hazardous products, along with humanization of the work process itself, would reduce deaths from cancer, heart disease, and violence; however, resistance to these changes is, and will remain, great. The socioeconomic and environmental changes that are necessary to afford each citizen an equal opportunity for optimal health will be adopted slowly, if at all. Considering the limited acceptability of these nonmedical strategies, the prospects for prevention are less than what has been promised. Despite its perfections, medical care can contribute to the prevention of early death and disability. Attempts to disparage it could delay the adoption of the changes needed to improve its effectiveness.

Activities of Daily Living↗

PubMed1992

Diabetes, exercise, and atherosclerosis.

Regular exercise may diminish the risk for atherosclerotic vascular disease in patients with non-insulin-dependent (type II) diabetes and in the general population. The basis for this effect of exercise may be its ability to diminish or prevent hyperinsulinemia, insulin resistance, and/or increases in intra-abdominal adipose mass. These abnormalities are associated with premature atherosclerotic vascular disease, essential hypertension, type II diabetes, and certain dyslipoproteinemias, and most likely precede them. They also have been implicated in the pathogenesis of these disorders. We propose that the high prevalence of hyperinsulinemia and insulin resistance in individuals leading a western life-style accounts for the reported benefit of physical activity in preventing coronary heart disease in the general population. We also propose that exercise (and diet) are most likely to be effective when initiated in young individuals, before the onset of irreversible vascular alterations, and when life-style changes may be more acceptable. Early identification of such individuals may be possible on the basis of family history, the presence of components of the hyperinsulinemia-insulin resistance syndrome, and/or central obesity. One such group that may already have been identified is women with gestational diabetes.

Arteriosclerosis↗

PubMed1989

Causative and intervening factors of harmful alcohol consumption and cannabis use in Malawi.

The aim of this study was to identify culturally relevant factors in the causation of and intervention in harmful alcohol and cannabis use in Malawi. Therefore a community research was conducted through key informants, and subjects were followed up for 6 months. The data were analyzed and interpreted according to an African model of socialization and personhood. It was concluded that traditional intervention strategies on a social and community level are no longer effective in the transitional Malawian, and that strategies aiming at basic life-style changes like those in some "Healing Churches" are called for.

Alcohol Drinking↗

PubMed1989

Cardiovascular disease-related knowledge and attitudes in a high-risk Australian population.

The population of Sydney's western suburbs has higher-than-average mortality rates of heart disease and has raised prevalence rates of the associated risk factors. To enquire into the cardiovascular disease-related knowledge, attitudes and behaviours of this population, a survey that used a multistage area-probability sampling method was conducted in May 1987. A total of 484 subjects was interviewed. The self-reported prevalence rates of angina, heart attacks, strokes and diabetes all were high compared with the rates from the Australia-wide National Heart Foundation's Risk Factor Prevalence Study in 1983. The rates of smoking, hypertension, high blood-lipid levels and sedentary life-style also were raised. Awareness of cardiovascular disease-related issues was high but detailed knowledge often was deficient. The majority of respondents reported having attempted to change their health-related behaviours. Of special note was the finding that 80% of current smokers had tried to quit smoking. The high level of awareness of the importance of making life-style changes, and the frequency with which attempts at behavioural changes were reported, suggest that improvements in the health of the population of Sydney's western suburbs will require two complementary strategies: the teaching of the skills that are needed to maintain healthy behaviours successfully and environmental changes to facilitate healthy life-style choices.

Adolescent↗

PubMed1992

Spouse adaptation to mate's CABG surgery: 1-year follow-up.

OBJECTIVE: The purpose of this study was to describe spouses' life stressors, supports, perceptions of illness severity, role strain, physical and mental symptoms of stress, and marital quality 1 year after the mate's coronary artery bypass graft surgery. METHODS: This descriptive study was the third component of a longitudinal panel investigation. (The first component was a period within 48 hours of surgery, and the second was 6 weeks after discharge.) One year after the mate's surgery, spouses received the following instruments in the mail: the Family Inventory of Life Events and Changes, the Norbeck Social Support Questionnaire, the Cantril Ladder Scale, the Strain Questionnaire, the Role Strain Scale and the Dyadic Adjustment Scale. Subjects were a convenience sample of 49 women whose husbands were alive 1 year after their first bypass surgery. Of the women in the sample (n = 49), 98% were white, and the mean age was 56 years. RESULTS: Social support was moderate and significantly less 1 year after surgery than during the first two components (48 hours and 6 weeks after surgery). Women still perceived their husbands to have some illness severity 1 year after surgery. They continued to have physical and mental symptoms of stress and had significantly greater role strain than during the first two periods. Marital quality was average. Spouses reported making several life-style changes. DISCUSSION: During the first year after the patient's bypass surgery, spouses experienced many changes. Although physical and mental symptoms of stress remained the same, role strain increased and social support decreased. The findings suggest testing of such interventions as stress management and time management techniques, support groups, and other psychoeducational interventions. CONCLUSIONS: Although the situation remains difficult for the spouse 1 year after the patient's surgery, nurses and physicians can foster and support spouses through many adjustments and changes.

Activities of Daily Living↗

PubMed1992

Personality disorders in obsessive compulsive disorder.

Standardized structured interview personality scales are now available that provide better reliability than clinician interview, but are still imperfect. These scales diagnose DSM III-R personality disorders, which are more illness-oriented than Freudian notions. Use of these scales has found that the majority of patients with OCD have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD, and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. The prevalence of this personality disorder as modified in DSM-III-R (making it easier for a patient to qualify for this personality disorder diagnosis) appears to be higher, although still present in a minority of patients with OCD. Obsessive compulsive personality disorder (along with the other cluster B and C personality disorders) has not been reported to have a consistent relation to treatment outcome. There is evidence that in some cases, obsessive compulsive personality disorder may be secondary to OCD. Swedo et al hypothesized that some children may develop compulsive personality traits as an adaptive mechanism to deal with OCD. This hypothesis is in accord with our finding that OCD often predates compulsive personality disorder and that mixed personality disorder may develop over time, possibly secondary to OCD. We found in our sample of 96 adult patients with OCD that the presence of mixed personality disorder was more likely with longer duration of OCD, suggesting that patients who do not have premorbid personality disorders may develop significant personality traits (especially avoidant, compulsive, and dependent), which may be related to behavioral and life-style changes that are secondary to OCD. This hypothesis is strengthened by our finding that patients with one of these personality disorders at baseline tended to no longer meet criteria for them following successful treatment of their OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia (e.g., in three male identical twin pairs concordant for OCD but discordant for schizophrenia or schizoaffective disorder, the nonpsychotic co-twins all had schizotypal personality disorder), is the only consistent personality disorder predictor of poorer outcome in OCD. These traits may help explain other proposed poor predictors of treatment outcome such as overvalued beliefs, poor compliance, and chaotic family situations.(ABSTRACT TRUNCATED AT 400 WORDS)

Comorbidity↗

PubMed1992

[Economic aspects of therapy for lipid metabolism disorders].

The primary and secondary prevention of cardiovascular diseases and, therefore, the therapy of hyperlipidemia is essential in strategies to lower morbidity and mortality from coronary heart disease (CHD), the most relevant atherosclerosis-associated disease. These programs imply not only a medical but also an economic challenge to our health system. That is why all therapeutic measures have to be evaluated regarding their cost-effectiveness. A cost-effectiveness profile was calculated for all the therapies of hyperlipidemia (nutritional therapy, dietetic nutritionals, drugs and LDL-apheresis) with respect to the following parameters: total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. The daily costs of all interventional measures are compared to the success rate, whereby an index of daily therapy costs and 1% change per lipid parameter was calculated. Nutritional therapy is by far the cheapest, and LDL-apheresis the most expensive but also the most effective and reliable therapeutic measure. It has to be considered, however, that dietary intervention can be very successful in overnutrition while in rare cases of severe homozygous familial hypercholesterolemia there is no therapeutic alternative to LDL-apheresis. Life-style modifications, such as changing nutritional habits, may contribute towards reducing or removing one or more risk factor(s) (e.g. malnutrition is associated with overweight, hyperlipoproteinemia (HLP), hyperinsulinemia (syndrome X), hyperfibrinogenemia and hypertension). But neither health politicians nor the population seem to be conscious of the fact that life-style changes help to reduce medical expenditure. Considering the fact that nearly every medical service is getting more and more expensive, the need to introduce financial regulations is evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗

PubMed1992

Current trends in the pharmacotherapy for gastroesophageal reflux disease.

Medical therapy for gastroesophageal reflux disease should entail a multistep approach. After life-style changes, many patients will require histamine2 receptor antagonists in conventional doses with repeated therapeutic courses, if not continuous maintenance. Prokinetic agents are potentially useful in those patients with impaired motor function of the esophageal or gastric smooth muscle. Combination therapy with histamine2 receptor antagonists and prokinetic agents or sucralfate provides modest healing benefit, if any, over that by histamine2 receptor antagonists alone. For patients with more severe refractory disease, omeprazole has provided unequaled healing rates and accelerated symptomatic relief. High-dose (twofold or more standard dose) histamine2 receptor antagonist therapy may also heal high-grade esophagitis, but the reported experience is small. After healing is achieved, an attempt should generally be made to "step down" therapy to standard-dose histamine2 receptor antagonist as maintenance. Finding the least amount of drug to control symptoms and maintain the integrity of the esophageal mucosa would minimize cost and potential long-term risk.

Costs and Cost Analysis↗

PubMed1992

The efficacy of inpatient education after myocardial infarction.

Nearly half a million Americans will survive an acute myocardial infarction (MI) this year. Nurses often question whether patients who have had an MI are able to absorb, retain, and use information given in the hospital. This review examines the research literature on inpatient education after MI published between 1975 and 1989 to determine (a) what information patients identify as most important, (b) whether inpatient education increases patients' knowledge, (c) whether anxiety prevents or diminishes learning in this setting, (d) whether inpatient education is able to produce lifestyle changes after discharge, and (e) which teaching methods are most effective. Patients identified risk factors as their primary concern. Most studies showed patients were able to learn new information, despite the presence of anxiety, particularly regarding activity after discharge. Inpatient education also stimulated some life-style change after discharge, most frequently in the areas of activity and smoking cessation. Several types of teaching methods were compared; audiovisual methods were found to be at least as effective as one-to-one patient teaching.

Health Behavior↗

PubMed1992

Community resources in obese care.

Community resources can augment care provided by physicians and dietitians for the obese. The well-distributed community resources in Florida are reviewed. They are well-established and provide emotional support, peer group dynamics, a variety of formats and prices, and information about food and life-style changes.

Humans↗

PubMedDate not supplied

Effect of health education in promoting prescription refill compliance among patients with hypertension.

A multifactorial health-education program designed to enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients enrolled in health maintenance organizations (HMOs). The initiation of the 180-day study period was used to classify patients as either new or existing cases of hypertension. In turn, patients in these two categories were randomly assigned to a control or an experimental group. Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription (new patients) or their first refill request (existing patients). The kit contained: a 30-day supply of atenolol; an educational newsletter about hypertension; information on nutrition and life-style changes; and an explanation of the intent and content of the program. Before the next scheduled prescription-refill date, each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of adherence to the regimen. Each month thereafter, the newsletter and an enclosed prescription-refill reminder were mailed to each patient. The medication possession ratio, defined as the number of days' supply of atenolol obtained by a patient during the 180-day study period, was significantly (P less than or equal to 0.001) enhanced for the new and existing experimental groups relative to the control groups. Multiple regression analyses revealed that enrollment in the health-education program increased the number of days' supply of atenolol obtained by existing patients by 27 (P less than or equal to 0.001), and by new patients by 40 (P less than or equal to 0.001).

Atenolol↗

PubMed1990

The medical management of reflux esophagitis. Role of antacids and acid inhibition.

Of the more than 60 million adult Americans who have heartburn at least once a month, 60% choose over-the-counter medication rather than consulting their physician. Those individuals who do seek medical advice for reflux symptoms will probably receive a prescription for an H2-receptor antagonist, although in many instances simple life-style changes and occasional use of antacids may provide effective therapy. Patients who have severe esophagitis or reflux symptoms unresponsive to H2-receptor antagonists may be treated with a more potent antisecretory agent (proton pump inhibitor). The author discusses the role of antacids and acid inhibition in the treatment of gastroesophageal reflux disease. The results of the clinical trials with the H2-receptor antagonists, cimetidine, ranitidine, famotidine, and nizatidine, and the proton pump inhibitor omeprazole, are compared and contrasted.

Antacids↗

PubMed1991

Safety belts and public health. The role of medical practitioners.

Medical practitioners have helped the public become aware of the importance of health-promoting life-style changes such as getting more exercise and abstaining from smoking. They can likewise help their patients protect themselves from the threat of automobile crash injury. Safety belt use remains too low, and increased use offers unusual potential for averting death and disability. Various characteristics associated with a failure to use safety belts can be used to help identify patients at high risk of traffic injury. These include male sex, persons who are ethnic minorities, young people, poor people, those with low educational levels, and persons with negative attitudes to seat belt use. Various methods and resources are available to help practitioners provide appropriate safety belt advice to patients, although the specific resources available vary from place to place. At a minimum, patients need to be told that a proper use of occupant protection can at least double the chances of avoiding death or severe injury in an automobile crash.

Adult↗

PubMed1990

[Changes in life style confronted by patients with chronic health conditions].

The purpose of this study was to identify the life style changes in patient with chronic illness. The sample consisted of 45 patients with chronic diseases. The findings showed that the patients had to face changes in their life Style such as: First, new tasks including compliance with terapeutic regimens seeking information about their diseases and managing their disconforts. Second, --losses referring to their social relationship, finances, locomotion and work capacity, and leisure activities losses. Third, treats --including treat to their personal self, their life and hope.

Brazil↗

PubMed1990

Counseling women at high risk for breast cancer.

Cancer risk analysis is a relatively new clinical service that has developed as more precise information has become available regarding specific risk factors. Both epidemiological and genetic factors contribute substantially to the identification of women at higher risk for developing breast cancer. The definition of what constitutes risk, an understanding of which factors influence risk, and the ability to present risk information clearly are critical features. In addition to providing information about risk and assessing each woman's perception of risk, the emotional issues must be addressed. The focus of intervention should center upon the benefits of early detection, assessment of breast self-examination skills, individualized breast cancer screening recommendations, such as mammography and physical exams, and recommendations for life style changes for possible prevention.

Breast Neoplasms↗

PubMed1989

Collaboration in action.

A neighborhood health center and a school of nursing in the southwest collaborated in a pilot project to offer two workshops for low-income, Hispanic diabetics. The collaboration process used participatory management and change theories, accepted and incorporated features of Hispanic culture, and fostered interpersonal relationships. The project enabled the center to augment its client education services while providing a teaching experience for nursing students. Through the workshops, clients gained knowledge and skills that enabled them to institute life-style changes in meal planning, medication management, exercise routines, and community involvement.

Community Health Centers↗

PubMedDate not supplied

Hypercholesterolemia. Prevention and control.

In the last few years, public concern about cholesterol has become a national preoccupation. Concerned consumers increasingly direct their questions about cholesterol to the nurses with whom they come in contact. Nurses in any setting who are knowledgeable about cholesterol are in an ideal position to teach current, accurate, potentially life-saving information about it. Nurses everywhere have a responsibility to assist consumers to achieve the goals of the National Cholesterol Education Program (NCEP) panel of experts within the next few years. This article describes the prevention and control of hypercholesterolemia through dietary and life-style changes. Drug therapy for control of hypercholesterolemia is discussed. Specific nursing interventions that are designed to assist people to achieve the NCEP goals are outlined.

Anticholesteremic Agents↗

PubMed1979

The development and evaluation of a behavioral weight-reduction program.

The development of a comprehensive weight-reduction program and its implementation in the clinic are described. The program consisted of explicit instructions on food monitoring, stimulus control, chaining, exercise, and self-reinforcement. The results of pilot research indicated that the program produced reliable weight loss and that its implementation in a group format was more positive. A formal experiment evaluated the effectiveness of program components in a 2 x 2 factorial design after ten weeks of treatment and at three-month and one-year follow-ups. There was significant weight loss with no main or interaction effects. At follow-up, those exposed to exercise and/or contingency management better maintained their weight loss or continued to lose. Data on the implementation of the program in a clinical setting are presented and these results compare favorably with reports from other clinics using behavior modification. It is suggested that our more positive results may be related to an emphasis on activity and life-style change in addition to changing eating behavior.

Adolescent↗