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PubMed2001

Continuous quality management of breast hypertrophy by the German Association of Plastic Surgeons: a preliminary report.

In 1998, the German Association of Plastic Surgeons started a new quality assurance program based on a standardized questionnaire to examine the tracer diagnosis "breast hypertrophy." The authors present the results of a pilot study evaluating 799 patients (mean age, 38 years). Breast reduction was performed as an inpatient procedure in 99% of patients. Mean weight reduction was 1,135 g (range, 140-3,870 g). The inverted-T scar technique was used in 45% of patients, the vertical scar technique in 52% of patients, and other techniques were restricted to 2% of patients. The selection of technique was based on the choice of the surgeon. The overall incidence of complications was 21.5%, and included predominantly wound dehiscence, without marked differences between the two techniques. Less than 10 years after the introduction of a new technique for breast reduction with reduced length of scar, it is now used as often as traditional methods.

Adolescent↗

PubMedDate not supplied

Metformin and carbohydrate-modified diet: a novel obesity treatment protocol: preliminary findings from a case series of nondiabetic women with midlife weight gain and hyperinsulinemia.

The authors conducted a retrospective analysis of a new obesity treatment protocol, metformin and hypocaloric, carbohydrate-modified diet, in high-risk, nondiabetic hyperinsulinemic women with progressive midlife weight gain (refractory to diet and exercise). Thirty consecutive nondiabetic women with glucose-mediated area-under-the-curve (AUC) insulin elevations (>or=100 microU/mL) in two body mass index (BMI) categories (group I: 25 to 32.9 kg/m(2) and group II: 33 to 41.7 kg/m(2)) participated in a 1-year treatment program of metformin (mean daily doses of 1,500 mg/day [group I] and 2,000 mg/day [group II]) and carbohydrate-modified dietary regimens. Follow-up body weight (at 3, 6, and 12 months), percentage of patients meeting goal weight attainment (10% reduction in body weight or BMI normalization), and fasting insulin levels (as available) are reported in 26 women (18/18 in group I and 8/12 in group II) who returned for one or more follow-up visits. Significant weight loss was observed at 3, 6, and 12 months in both group I (3.47 [SE 0.68], 6.41 [0.72], and 8.06 [0.96] kg, P < 0.0001) and group II (4.4 [0.8], 9.7 [2.3], 15.1 [3.3], P = 0.001, 0.004, 0.011). Twenty-five of 26 (96%) patients lost >or=5% of their body weight at 6 months and 21/26 (81%) patients lost >or=10% of their body weight at 12 months. Posttreatment fasting insulin decrement (-35.5 [8.2]%) was the most significant predictor of 1-year weight loss (R(2)=0.656, regression coefficient = 0.810, P = 0.005). Following completion of the 1-year intervention study, weight stabilization (within 1 kg) was observed at a 6-month surveillance in 8/9 patients who attained goal weight and continued metformin without additional nutritional counseling, in contrast to weight gain (>or=4 kg or 50% of lost weight) in 5/6 patients who discontinued metformin. The authors concluded that metformin and carbohydrate-modified hypocaloric diet could be an effective novel treatment for long-term weight management in nondiabetic, hyperinsulinemic women.

Area Under Curve↗

PubMed1978

[Biochemical measures in cardiac patients: an analysis of change during rehabilitation (author's transl)].

210 male patients hospitalized for cardiac rehabilitation have been studied. As a result of age matching the sample was reduced to 190 patients: 72 patients with myocardial infarction, 90 patients with functional cardiovascular diseases, and 28 patients with angina pectoris. At the beginning and at the end of the 4 to 6 week rehabilitation program total lipids, cholesterol, triglycerides, phosphatides, GOT, GPT, LDH, HBDH, cholinesterase, aldolase, blood sugar, creatinine, electrolytes, hemoglobin, erythrocytes, leukozytes, and catecholamines were measured. In addition to the statistical comparison of the three groups and their specific change patterns, effects of body weight reduction and improvement of physical fitness were analyzed. The decrease of lipids is especially associated with weight reduction, whereas the decrease of enzyme activity and electrolyte concentration is accompanied as well with weight reduction as with the improvement of physical fitness.

Adult↗

PubMed1989

Fatty acid composition in serum lipids and adipose tissue in severe obesity before and after six weeks of weight loss.

Fatty acid composition was studied in 25 grossly obese patients (mean weight 116 +/- 21 (s.d.) kg) before and after 6 weeks of treatment with a combined program consisting of diet, behavioral modification and light exercise. Data were compared with results from nonobese controls. In obese patients the most marked differences were reduced relative contents of linoleic acid in serum triglycerides (P less than 0.001), cholesterol esters (P less than 0.05) and phospholipids (P less than 0.001). Linolenic acid was reduced in serum triglycerides (P less than 0.001) and in cholesterol esters (P less than 0.01). There were reciprocal increases in palmitic and palmitoleic acid (P less than 0.05) in these two serum lipid fractions. In adipose tissue of obese patients only minor differences were found in palmitoleic acid, which was increased, and in the saturated fatty acids with 14, 16 and 18 carbon atoms which were decreased. Weight loss (600 kcal/day for 6 weeks, P/S ratio about 0.5) did not affect adipose tissue fatty acid composition, but resulted in reductions of linoleic acid content in cholesterol esters and phospholipids, with reciprocal increases of palmitic and arachidonic acid in these fractions. Our results suggest that obese patients have low essential fatty acids content in their circulating plasma lipids already in a weight stable phase. Therefore it may be argued that in the development of long-term dietary restriction programs attention should be paid to the quality of the dietary fat.

Adipose Tissue↗

PubMed2000

Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian aboriginal community.

OBJECTIVE: To assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia. METHOD: Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n = 49, followed over two years) and cross-sectional community samples (n = 200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour). RESULTS: For the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management. CONCLUSIONS: Community control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease. IMPLICATIONS: Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.

Adult↗

PubMed1996

Developing effective strategies for malaria prevention programs for pregnant African women.

The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. Persistently low program coverage coupled with diminishing intervention effectiveness have forced a re-evaluation of the relative importance of malaria in pregnancy. The Mangochi Malaria Research Project (MMRP), a prospective evaluation of malaria prevention in pregnant women in rural Malawi conducted during 1987-1990, contributed to establishing new criteria for policy and program development for malaria prevention in pregnancy. The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.

Africa↗

PubMed2003

Predictable postural perturbation in premotor and motor components of reaction time.

The aim of the present experiment was to study the central control of posture and movement coordination. Subjects' task was voluntarily to raise their arms in response to a visual signal, this movement generating an unloading in which the weight of the load (0 gm, 1500 gm, 3000 gm, or 4500 gm) was known in advance. Thus, subjects could predict the postural perturbation generated by the unloading. Analysis showed an effect of the unloading conditions: in the 0-gm and 1500-gm conditions, reaction time (RT) was longer than in the 3000-gm and 4500-gm conditions. This decrease in RT was exclusively due to a reduction of the premotor time, confirming the posturokinetic coordination in the programming processes. The implications of the decrease in premotor time with the increase of the perturbation for the posture/movement coordination strategies are also discussed.

Adult↗

PubMed1990

Neonatal morphometrics after endurance exercise during pregnancy.

This study was designed to test the hypothesis that continuation of a regular running and/or aerobics program during late pregnancy at or above 50% of preconceptional levels limits fetal growth. Accordingly, detailed neonatal morphometric data were gathered in the offspring of two groups: 77 well-conditioned recreational runners and aerobic dancers who were delivered at term after continuing their exercise regimen at or above 50% of the preconceptional level throughout pregnancy and 55 matched controls. Daily exercise performance was quantitated before conception and throughout pregnancy. Significant reductions in birth weight (-310 gm), birth weight percentile (-20), ponderal index (-0.24), its percentile (-30), and the fetoplacental weight ratio (-0.7) were seen in the offspring of the exercise group whereas crown-heel length (51.4 cm) and head circumference (35.0) were similar in the two groups. Reductions in two-site skin-fold thickness (-1.5 mm), skin-fold percentile (-30), calculated percent body fat (-5.0%), and fat mass (-220 gm) in the offspring of the exercise group confirmed the asymmetric pattern of growth restriction and indicated that approximately 70% of the difference in birth weight could be explained by the difference in neonatal fat mass. In runners, the relative level of exercise performance in the last 5 months of pregnancy explained 40% of the variability in birth weight over an 1100 gm birth weight range. We conclude that continuation of a regular aerobic or running program at or above a minimal training level during late pregnancy results in an asymmetric pattern of growth restriction that primarily impacts on neonatal fat mass.

Adult↗

PubMed1993

Protein topology prediction through parallel constraint logic programming.

In this paper, two programs are described (CBS1e and CBS2e). These are implemented in the parallel constraint logic programming language ElipSys. These predict protein alpha/beta-sheet and beta-sheet topologies from secondary structure assignments and topological folding rules (constraints). These programs illustrate how recent developments in logic programming environments can be applied to solve large-scale combinatorial problems in molecular biology. We demonstrate that parallel constraint logic programming is able to overcome some of the important limitations of more established logic programming languages i.e. Prolog. This is particularly the case in providing features that enhance the declarative nature of the program and also in addressing directly the problems of scaling-up logic programs to solve scientifically realistic problems. Moreover, we show that for large topological problems CBS1e was approximately 60 times faster than an equivalent Prolog implementation (CBS1) on a sequential device with further performance enhancements possible on parallel computer architectures. CBS2e is an extension of CBS1e that addresses the important problem of integrating the use of uncertain (weighted) protein folding constraints with categorical ones, through the use of a cost function that is minimized. CBS2e achieves this with a relatively minor reduction of performance. These results significantly extend the range and complexity of protein structure prediction methods that can reasonably be addressed using AI languages.

Artificial Intelligence↗

PubMed1976

Protein and calorie malnutrition among preschool Navajo Indian children, a follow-up.

A follow-up study was conducted on the infant and child-feeding programs to determine the prevalence of protein and calorie malnutrition among preschool Navajo Indian children. These programs were introduced on the reservation in 1968. The numbers of patients admitted to the Public Health Service Indian Hospital, in Tuba City, Arizona, with deficits in weight for their chronological ages, marasmus, and kwashiorkor were compared during two 5-year-periods, 1963 to 1967 and 1969 to 1973. The results show an 18% reduction in the total number of patients under 5 years of age admitted to the hospital and a 39% reduction in the number of patients admitted with deficits in weight for their chronological ages. Marasmus has practically disappeared, with only two cases described since the end of fiscal 1969. The number of cases of kwashiorkor has also decreased by 50%, mainly in the last 4 years. The height and weight data on 1,462 Head Start children from all over the reservation were measured in September 1973, and these measurements were compared with data obtained in September 1967. While they still show a significant deviation from the Boston growth curves, there is a definite improvement from 1967 to 1973. This improvement was especially noticeable in height. Thirty percent of the girls and 30% of the boys fell below the 3rd percentile for Boston in 1967. In 1973, these figures were 11% and 16%, respectively. In the case of the girls in 1973, the numbers below the 3rd percentile are significantly smaller for younger girls than for the older girls, suggesting that the growth retardation occurred in the first 2 years of life, and that the older children had not received the full benefit of the free infant formula feeding programs. This trend, however, was not present in boys. It is concluded that the infant and child feeding programs have contributed to improved growth among Navajo preschool children. At the same time, concern is expressed that these feeding programs will be replaced by a Food Stamp Program and that the gains made will be reversed. Concern is also expressed for the regressive effects of inflation and rising food prices and the effects they will have on the nutritional status of the Navajo people.

Arizona↗

PubMed2005

Rebound weight gain as associated with high plasma norepinephrine levels that are mediated through polymorphisms in the beta2-adrenoceptor.

BACKGROUND: A successful weight loss program is essential treatment for obesity-related diseases, but it is well known that the majority of individuals do not succeed in weight loss maintenance. The present study evaluates hormonal mechanisms and the relationship of beta2-adrenoceptor polymorphisms involved in individuals who regain weight after initially successful weight loss. METHODS: Overweight Japanese men (n = 154) were enrolled in a 24-month weight loss program. Body mass index (BMI), total body fat mass, plasma norepinephrine (NE) and leptin levels, and beta2-adrenoceptor polymorphisms (Arg16Gly, Gln27Glu) were measured every 6 months for the 24-month period. Maintenance of weight loss was defined as significant weight loss (>or=10% reduction) from entry weight at 6 months and maintenance of the weight loss for an additional 18 months. Rebound weight gain was defined as significant weight loss at 6 months but subsequent regain of body weight during the next 18 months. RESULTS: The results showed that 37 subjects maintained weight loss during 24 months, whereas 36 subjects had rebound weight gain. The BMI at entry and calorie intake and physical activity at each period were similar between the two groups. Subjects who maintained weight loss had at entry a significantly lower fat mass and plasma NE levels compared to those with rebound weight gain. Body fat mass, NE, and leptin levels at entry predicted the degree of change in body weight during the 24-month study period. Subjects with rebound weight gain had a significantly higher frequency of the Gly16 allele for the beta2-adrenoceptor polymorphism compared to subjects who had a 24-month maintenance of weight loss. Subjects carrying the Gly16 allele also had significantly higher plasma NE, leptin, and body fat mass levels and a greater waist-to-hip ratio both at entry and throughout the study. CONCLUSIONS: A high initial degree of body fat mass and high plasma NE levels as determined by the Gly16 allele for the beta2-adrenoceptor polymorphisms predict those individuals who will have rebound weight gain after their initial successful weight loss.

Adult↗

PubMed1988

Altitude and childhood growth.

To assess the possible influence of altitude on childhood growth in the United States, we used data collected by the Centers for Disease Control Pediatric Nutrition. Surveillance System from eight mountain states to determine the height and weight status of children aged 5 years or younger enrolled in various public health programs between 1982 and 1984. The mean birth weight, height-for-age, weight-for-age, and weight-for-height indicators were found to decline significantly with increasing altitude, starting at an elevation greater than 1500 m (p less than 0.001, ANOVA). The reduction in growth was observed for all age groups and all birth weight groups studied. Part of the observed reduction in growth could be attributed to the lower birth weight of children born at higher altitude. However, the reduced growth status persisted after controlling for birth weight, suggesting the presence of an extrauterine growth retardation effect related to altitude.

Altitude↗

PubMed2001

Patients attachment patterns and response to a program for alleviating cardiovascular risk factors: a 1-year follow-up of patients in a patient education program.

This study was a 1-year follow-up of 295 consecutive patients at a patient education centre and assessed how attachment style influenced the outcome of the patient education program devised for individuals with multiple risk factors for cardiovascular disease. The program consisted of a 4-week residential program course, followed by a 4-day follow-up course a year later. In our cohort study, the 295 consecutive patients (mean age = 52years, S.D.=9.2) with multiple risk factors for cardiovascular disease, showed an initial overall reduction of 4.4 kg in weight (P=0.0001) and a reduction of 17/11 mm in systolic and diastolic blood pressure (P=0.0001 and 0.0001). The weight remained essentially the same at the follow-up 1 year later, whereas blood pressure tended to return to previous level. The attachment style was determined by means of a questionnaire: 87% were classified as 'secure', 9% 'avoidant' and 5% as 'ambivalent'. After 4 weeks, the ambivalent category had reduced weight (body mass index (BMI)) more than the secure group (P=0.04). At the 1-year follow-up, the avoidant category showed a more pronounced reduction in diastolic blood pressure than the other groups (P=0.001). Thus, it seems as if attachment style does have some influence on outcome. Patient education should take advantage of knowing patients' attachment style.

Cardiovascular Diseases↗

PubMedDate not supplied

Prevention and treatment of the metabolic syndrome.

The prevalence of the metabolic syndrome is increasing owing to lifestyle changes leading to obesity. This syndrome is a complex association of several interrelated abnormalities that increase the risk for cardiovascular disease and progression to diabetes mellitus (DM). Insulin resistance is the key factor for the clustering of risk factors characterizing the metabolic syndrome. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III defined the criteria for the diagnosis of the metabolic syndrome and established the basic principles for its management. According to these guidelines, treatment involves the improvement of the underlying insulin resistance through lifestyle modification (eg, weight reduction and increased physical activity) and possibly by drugs. The coexistent risk factors (mainly dyslipidemia and hypertension) should also be addressed. Since the main goal of lipid-lowering treatment is to achieve the NCEP low-density lipoprotein cholesterol (LDL-C) target, statins are a good option. However, fibrates (as monotherapy or in combination with statins) are useful for the treatment of the metabolic syndrome that is commonly associated with hypertriglyceridemia and decreased high-density lipoprotein cholesterol (HDL-C) levels. The blood pressure target is < 140/90 mm Hg. The effect on carbohydrate homeostasis should possibly be taken into account in selecting an antihypertensive drug. Patients with the metabolic syndrome commonly have other less well-defined metabolic abnormalities (eg, hyperuricemia and raised C-reactive protein levels) that may also be associated with an increased cardiovascular risk. It seems appropriate to manage these abnormalities. Drugs that beneficially affect carbohydrate metabolism and delay or even prevent the onset of DM (eg, thiazolidinediones or acarbose) could be useful in patients with the metabolic syndrome. Furthermore, among the more speculative benefits of treatment are improved liver function in nonalcoholic fatty liver disease and a reduction in the risk of acute gout.

Adipocytes↗

PubMed1999

Lifestyle Changes That Reduce Blood Pressure: Implementation in Clinical Practice.

Lifestyle modification is widely advocated as initial and adjuvant therapy for the treatment and prevention of hypertension. In addition to exercise, nutritional changes including sodium reduction, adoption of the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and weight loss have significant blood pressure lowering effects. The current challenge to clinicians has been developing and implementing practical and effective approaches for use in clinical practice. This review discusses the evidence supporting each current lifestyle recommendation, discusses evidence on specific programs or office based strategies, and provides practical advice. (c)1999 by Le Jacq Communications, Inc.

Journal Article↗

PubMed1992

Hypertension and insulin resistance.

Insulin resistance and hyperinsulinemia is now recognized in non-insulin-dependent diabetes, essential hypertension, obesity, atherosclerotic heart disease, dyslipidemia, heart failure, and in heavy smokers. Several mechanisms have been proposed to explain hyperinsulinemia, insulin resistance and its relationship to hypertension; reduced sodium excretion, activation of the sympathetic nervous system, increased activity of the sodium/hydrogen pump, and stimulation of cellular growth. Some of the nonpharmacological methods to control hyperinsulinemia are of benefit in the management of hypertension, most notably weight loss, exercise program, and reduced salt intake. High-fiber and reduced-protein diets also reduce hyperinsulinemia. Thiazide diuretics can result in insulin resistance, and insulin secretion may be inhibited, possibly associated with concomitant hypokalemia. beta-Blockers result in some reduction of glucose tolerance and mask some of the features of hypoglycemia. Angiotensin-converting enzyme (ACE) inhibitors and alpha-receptor blockers do not effect insulin resistance; probably the same is true for calcium antagonists. Although the effect on risk factors should not be discounted, it is the effect of treatment on hard end points, cerebrovascular accidents, myocardial infarction, or death that is most important. Evidence in hypertension is at present restricted to diuretics and beta-blocking drugs.

Animals↗

PubMedDate not supplied

Dietary changes among husbands of participants in a low-fat dietary intervention.

A dietary intervention delivered to one family member with a beneficial impact on other members could provide a cost-effective approach to public health dietary intervention programs. The Women's Health Trial (WHT) was a study in which women were randomized to be trained in adopting a low-fat diet or to continue their normal diet. The intervention women consumed 21% of total calories from fat versus 38% for control women at six months postrandomization. Husbands of women in the Seattle Clinical Center of the WHT were surveyed between 1985 and 1988 to determine whether and to what extent the husbands' diets changed at six months. Ninety-one intervention men and 162 control men, 79% of those eligible, participated. Intervention men reported an average weight loss of 2.4 pounds, compared to an average 0.7-lb loss among controls (P = .03). Based on self-reported change of specific foods, we found that intervention men more often reduced butter, margarine, eggs, and red meat over the six months than did control men (P less than .001). Based on nutrient consumption estimated by a food frequency questionnaire, intervention husbands consumed 34% of total calories from fat versus 36% for controls (P = 0.04). The number of meals shared with wives per week modified the effect of the intervention: among the intervention group, for every three meals shared, an accompanying one percentage point reduction in percentage of calories from fat occurred in the husband's diet. Thus, we suggest that dietary intervention programs attended by one spouse appear to exert a small beneficial effect on the other spouse.

Aged↗

PubMed2006

Projection of hazardous air pollutant emissions to future years.

Projecting a hazardous air pollutant (HAP) emission inventory to future years can provide valuable information for air quality management activities such as prediction of program successes and helping to assess future priorities. We have projected the 1999 National Emission Inventory for HAPs to numerous future years up to 2020 using the following tools and data: the Emissions Modeling System for Hazardous Air Pollutants (EMS-HAP), the National Mobile Inventory Model (NMIM), emission reduction information resulting from national standards and economic growth data. This paper discusses these projection tools, the underlying data, limitations and the results. The results presented include total HAP emissions (sum of pollutants) and toxicity-weighted HAP emissions for cancer and respiratory noncancer effects. Weighting emissions by toxicity does not consider fate, transport, or location and behavior of receptor populations and can only be used to estimate relative risks of direct emissions. We show these projections, along with historical emission trends. The data show that stationary source programs under Section 112 of the Clean Air Act Amendments of 1990 and mobile source programs which reduce hydrocarbon and particulate matter emissions, as well as toxic emission performance standards for reformulated gasoline, have contributed to and are expected to continue to contribute to large declines in air toxics emissions, in spite of economic and population growth. We have also analyzed the particular HAPs that dominate the source sectors to better understand the historical and future year trends and the differences across sectors.

Air Pollutants↗