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PubMed1986

Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation.

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

Birth Weight↗

PubMed2002

The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program.

PURPOSE: To study the relationship of physical activity and obesity with all-cause mortality in Puerto Rican Men. METHODS: The Puerto Rico Heart Health Program collected physical activity and anthropometric measurements in 9,824 men between 1962 and 1965. After excluding those with known coronary heart disease at baseline, and those who died within the first three years of the study we analyzed the data for the relationship between physical activity and overweight status to all-cause mortality in 9,136 men. We stratified our participants by quartiles of physical activity. Participants were classified into four categories of body weight: underweight (BMI < 18.5), healthy weight (BMI =18.5-24.9), overweight (BMI = 25-29.9), and obese (BMI = 30+). RESULTS: After adjusting for age, education, smoking status, hypertension status, hypercholesterolemic status, urban/rural residence, and overweight status, physical activity was independently related to all-cause mortality. All-cause mortality was lower in those in quartile 2 (OR = 0.68, CI = 0.58-0.79) than quartile 1 (reference, sedentary group). Mortality among those in quartile 3 and 4 (0.63, CI = 0.54-0.75; and 0.55, CI = 0.46-0.65, respectively) were also significantly lower than those observed in quartile 1, but not significantly lower than those observed in quartile 2. Furthermore, within every category of body weight, those who were most active had significantly lower odds ratio of all-cause mortality. CONCLUSION: Our findings support the current recommendation that some physical activity is better than none, in protecting against all-cause mortality. The benefits of an active lifestyle are independent of body weight and that overweight and obese Puerto Rican men who are physically active experienced significant reductions in all-cause mortality compared with their sedentary counterparts.

Body Mass Index↗

PubMed1995

Reduction in mitochondrial potential constitutes an early irreversible step of programmed lymphocyte death in vivo.

In a number of experimental systems in which lymphocyte depletion was induced by apoptosis-inducing manipulations, no apoptotic morphology and ladder-type DNA fragmentation were detected among freshly isolated peripheral lymphocytes ex vivo. Here we report that one alteration that can be detected among splenocytes stimulated with lymphocyte-depleting doses of dexamethasone (DEX) in vivo is a reduced uptake of 3,3'dihexyloxacarbocyanine iodide (DiOC6[3]), a fluorochrome which incorporates into cells dependent upon their mitochondrial transmembrane potential (delta psi m). In contrast, ex vivo isolated splenocytes still lacked established signs of programmed cell death (PCD):DNA degradation into high or low molecular weight fragments, ultrastructural changes of chromatin arrangement and endoplasmatic reticulum, loss in viability, or accumulation of intracellular peroxides. Moreover, no changes in cell membrane potential could be detected. A reduced delta psi m has been observed in response to different agents inducing lymphoid cell depletion in vivo (superantigen and glucocorticoids [GC]), in mature T and B lymphocytes, as well as their precursors. DEX treatment in vivo, followed by cytofluorometric purification of viable delta psi mlow splenic T cells ex vivo, revealed that this fraction of cells is irreversibly committed to undergoing DNA fragmentation. Immediately after purification neither delta psi mlow, nor delta psi mhigh cells, exhibit detectable DNA fragmentation. However, after short-term culture (37 degrees C, 1 h) delta psi mlow cells show endonucleolysis, followed by cytolysis several hours later. Incubation of delta psi mlow cells in the presence of excess amount of the GC receptor antagonist RU38486 (which displaces DEX from the GC receptor), cytokines that inhibit DEX-induced cell death, or cycloheximide fails to prevent cytolysis. The antioxidant, N-acetylcysteine, as well as linomide, an agent that effectively inhibits DEX or superantigen-induced lymphocyte depletion in vivo, also stabilize the DiOC6(3) uptake. In contrast, the endonuclease inhibitor, aurintricarboxylic acid acts at later stages of apoptosis and only retards the transition from the viable delta psi mlow to the nonviable fraction. Altogether, these data suggest a sequence of PCD-associated events in which a reduction in delta psi m constitutes an obligate irreversible step of ongoing lymphocyte death, preceding other alterations of cellular physiology, and thus allowing for the ex vivo assessment of PCD.

Animals↗

PubMed2002

The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study.

OBJECTIVE: To determine the safety, feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome (FMS). METHODS: Fifteen women with confirmed FMS were monitored for injury and exercise compliance, and assessed for muscle strength (1-repetition maximum technique), cardiovascular endurance (6-minute walk test), and functional status (Fibromyalgia Impact Questionnaire [FIQ]) before and after a 20-week exercise intervention. RESULTS: Zero injuries and an 81% compliance rate occurred during training. Improvement was seen in muscle strength of the lower (191 +/- 75 to 265 +/- 67 pounds; P < 0.001) and upper (61 +/- 18 to 76 +/- 18 pounds; P < 0.001) body, 6-minute walk distance (530 +/- 80 to 629 +/- 74 meters; P < 0.001), and in FIQ score (44 +/- 9 to 32 +/- 14; P < 0.01). CONCLUSION: A program of progressive strength training and cardiovascular exercise can be safe, well tolerated, and effective at improving muscle strength, cardiovascular endurance and functional status in women with FMS without exacerbating symptoms. This program may also contribute to a reduction in the severity of several symptoms.

Adult↗

PubMed2000

Evaluation of normal yellow dent corn and high available phosphorus corn in combination with reduced dietary phosphorus and phytase supplementation for broilers grown to market weights in litter pens.

A study was conducted to determine the extent fecal P levels could be reduced while maintaining performance. Various strategies were employed including the use of a high available phosphorus hybrid of corn (HAPC), supplementation with phytase enzyme, and reduced dietary P levels. The use of HAPC resulted in a 50% reduction in phytate-bound dietary P as compared with a normal yellow dent corn (YDC) diet. Dietary nonphytate P was maintained at either NRC (1994) recommendations for appropriate age periods or reduced by 0.075 or 0.15%. Portions of the diets were supplemented with 1,000 units of phytase/kg. Male chicks of a commercial strain were grown to 56 d on the test diets. Broilers fed diets with HAPC had BW, feed conversion, livability, and tibia ash that were equal to or superior to those fed diets with YDC with considerably reduced fecal P content at any dietary level of nonphytate P. Phytase supplementation enabled birds to maintain live performance at lower levels of nonphytate P, further reducing the fecal P output. One of the greatest contributions of phytase was a reduction in mortality at the lower levels of nonphytate P. Dietary P levels could be reduced by 0.075% under NRC (1994) recommendations without adversely affecting live performance; a reduction of 0.15% in conjunction with phytase supplementation maintained BW, feed conversion, and livability but reduced tibia ash. The extent to which dietary P levels can be reduced over the entire feeding program is subject to further research.

6-Phytase↗

PubMed2001

[Long-term results of the reduction mammaplasty with Revers T-technique].

Functional and aesthetic aspects make the reduction mammaplasty a favoured surgical procedure. The vertical technique, as well as the technique with central pedicle have clearly gained in importance next to the traditional T-cut technique. We provided questionnaires to a random sample of 110 patients who had been treated according to the method of Strömbeck-Weiner. The results were evaluated and compared with the literature. Our results show that the functional complaints were largely eliminated by the surgery and that the patients experienced a significant improvement in their psychological well being. The applied method produces a satisfactory shape of the breast with programmed ptosis, and to large extent retains the nipple-areola sensitivity. One shortcoming of this procedure is the scar formation which 20 % of the patients found bothering. However, 94 % of the patients would choose the procedure again. We conclude that the reduction mammaplasty with reverse T-technique according to Strömbeck-Weiner continues to be of value for patients with a desired weight reduction of more than 500-600 g and patients over the age of fourty.

Adolescent↗

PubMed1980

Effects of physical training and food restriction on insulin secretion and glucose tolerance in male and female rats.

The purpose of this study was to assess the respective effects of physical training, adiposity, and total body mass on insulin secretion and glucose tolerance. Male and female rats were used in two separate studies. In a first study male rats were divided into three groups sedentary free-eating control (c), exercise-trained (T), and sedentary pair-weighted. In a second study with female rats, three groups were formed: C, T, and a sedentary food-restricted group. In the two studies, at the end of the training program, the animals were subjected to an intravenous insulin levels without any impairment of glucose tolerance. However, essentially the same results were obtained with both the pair-weighted male rats and the food-restricted female rats. These results suggest that the reduced levels of plasma insulin observed in trained rats challenged or not by a glucose load, could be explained by the reduction of body mass caused by exercise training.

Adipose Tissue↗

PubMed2002

The influence of remifentanil on the dynamic relationship between sevoflurane and surrogate anesthetic effect measures derived from the EEG.

BACKGROUND: The authors modeled the influence of remifentanil on the dynamics of sevoflurane using three parameters derived from the electroencephalogram: 95% spectral edge frequency (SEF), canonical univariate parameter (CUP), and Bispectral Index (BIS). METHODS: Thirty-six patients with American Society of Anesthesiologists physical status class I or II were recruited, of which 12 received a target remifentanil concentration of 0 ng/ml, eight 2 ng/ml, eight 4 ng/ml, and another eight 8 ng/ml. Next (before surgery), several step-wise changes in the end-tidal sevoflurane concentration (F(ET,sevo)) were performed. A data acquisition system simultaneously recorded F(ET,sevo), the raw electroencephalogram, BIS, and SEF. The authors used a combination of an effect compartment and an inhibitory sigmoid E(MAX) model to describe the relation between F(ET,sevo) and BIS, SEF, and CUP. Model parameters (t(1/2)k(e0), E(MAX), E(MIN), C(50), gamma, CUP weight factors) were estimated using the population data analysis program NONMEM. Significant remifentanil model parameter dependencies (P < 0.01) were determined. RESULTS: Determined from SEF, remifentanil had no effect on t(1/2)k(e0) (1.91 +/- 0.26 min [mean +/- standard error]) but caused an increase in C(50) (baseline = 1.48 +/- 0.12%; 80% increase at 8 ng/ml) and decrease in E(MIN) (baseline = 10.8 +/- 0.6 Hz; 80% reduction at 8 ng/ml). Determined from CUP, remifentanil caused a dose-dependent decrease in t(1/2)k(e0) (baseline = 4.31 +/- 1.00 min; 60% decrease at 8 ng/ml), with no effect on C(50) (baseline = 0.88 +/- 0.13%). Determined from BIS, remifentanil caused a dose-dependent decrease in t(1/2)k(e0) (baseline value = 3.11 +/- 0.32 min; 40% decrease at 8 ng/ml), without affecting C(50) (baseline = 1.12 +/- 0.05%). Median R(2) values of the pooled data set were 0.815 for SEF, 0.933 for CUP (P < 0.01 vs. SEF), and 0.952 for BIS (P < 0.01 vs. SEF and CUP). Addition of remifentanil increased the R(2) values for CUP only. CONCLUSIONS: Remifentanil accelerates sevoflurane blood-brain equilibration without affecting its hypnotic potency as determined from BIS and CUP. In terms of R(2), the authors' pharmacodynamic model describes the anesthetic-BIS relation best.

Adult↗

PubMed2004

Coronary risk factor management in the framework of a community hospital-based ambulatory exercise training program.

Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (-4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (-2%), systolic blood pressure (-3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease.

Blood Pressure↗

PubMed1989

Behavioral strategies for weight reduction in obese type II diabetic patients.

This article reviews strategies that have been shown to be helpful in the treatment of obesity and are applicable to obese type II (non-insulin-dependent) diabetic patients. Emphasis is placed on the use of behavior modification strategies, including careful description of the behavior to be changed, setting of goals for new behavior, and procedures for modifying the environmental cues and reinforcers that control behavior. It is recommended that weight-loss programs for obese diabetic patients include intensive long-term contact with the patient, therapists with training in behavior modification, and a multifaceted intervention involving behavior modification, diet, and exercise.

Behavior Therapy↗

PubMed1996

Changes in intubation rates and outcome of very low birth weight infants: a population-based study.

OBJECTIVE: There have been indications of a recent decrease in intubation rates of very low birth weight (VLBW) infants in Germany. We wanted to quantify this decrease and analyze its effect on clinical outcome. METHODS: Population-based data on the treatment and outcome at hospital discharge from a statewide quality assurance program were analyzed for 2001 VLBW infants (500 to 1499 g) born from 1992 to 1994 in Lower Saxony, North Germany. RESULTS: The proportion of patients not intubated and mechanically ventilated increased from 7% to 14% in infants less than 1000 g and from 28% to 44% in those greater than or equal to 1000 g (P < .02 and < .01, respectively). This increase was not associated with any significant increase in adverse outcome such as death, intraventricular hemorrhage, periventricular leucomalacia, or bronchopulmonary dysplasia (BPD). Instead, there was an increase in the proportion of infants less than 1000 g who survived without BPD (from 38% in 1992 to 48% in 1994; P < .05) and a decrease in the proportion of infants greater than or equal to 1000 g in whom BPD developed (from 14% to 9%; P < .05). CONCLUSIONS: The data from a statewide quality assurance program show a significant reduction in the aggressiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. This observational study, however, cannot define whether a more selective approach to the intubation of VLBW infants will ultimately result in a better outcome. A randomized, controlled trial would be required to answer this clinically important question.

Germany↗

PubMed2000

Acquired immunodeficiency syndrome wasting, functional performance, and quality of life.

Unintentional loss of weight and lean body mass (wasting) is a major cause of morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Patients with AIDS wasting (AW) often experience reductions in lean body mass, muscle strength, and the ability to perform functions of daily living. Dependence on assistance with activities of daily living may be associated with a lower quality of life (QOL) and higher risk of mortality. These factors suggest that slowing or reversing the loss of lean body mass in AW can improve well-being. Nutritional support or appetite stimulants in the absence of exercise therapy or growth hormone supplementation can increase fat without improving body composition, whereas appropriate exercise programs, androgen therapy, and recombinant human growth hormone (rhGH) therapy may increase lean body mass in patients with AW. Resistance exercise programs can increase muscle strength and lean body mass. In addition, both resistance and endurance (aerobic) exercise augment endogenous growth hormone levels, decrease depression, enhance self-esteem, and may improve immune response. Randomized, double-blind trials have shown that rhGH therapy increases total body weight, lean body mass, exercise capacity, and QOL. In summary, interventions that improve exercise capacity and functional performance may enhance QOL in patients with AW and may reduce mortality in this group.

Activities of Daily Living↗

PubMed1995

Physicians and nurses can be effective educators in coronary risk reduction.

OBJECTIVES: 1) To compare the impact of a brief physician or nurse education session with the impact of education provided by dietitians on patient knowledge regarding coronary risk factors, dietary recommendations, and compliance, and 2) to determine the value of additional formal dietary counseling on knowledge, dietary fat, and serum lipids. DESIGN: Primary care physicians and their office nurses were compared with inpatient dietitians by evaluating patient performance on a standardized test and three-day dietary food choices. Neither the educators nor the patients were aware of the study. Supplemental information was provided by a study dietitian and patients were reevaluated six weeks later. SETTING: Preventive cardiology program in a university-affiliated teaching hospital. PARTICIPANTS: Fifty consecutive patients referred to a preventive cardiology program who had received dietary and cardiac risk factor information within the preceding six weeks by a physician and office nurse (27) or an inpatient dietitian (23) were enrolled. Forty-five patients completed the study objectives. INTERVENTIONS: The patients completed a three-day food record, fasting lipids, and a test of knowledge of coronary risk factors and dietary concepts. The correct answers were discussed and a standard American Heart Association phase I diet was recommended. Six weeks later dietary food records, fasting lipids, and the test were repeated. MEASUREMENTS AND MAIN RESULTS: By participant recall, the dietitians (group II) spent an average of 30.6 +/- 25 minutes, compared with 8.2 +/- 14.4 minutes by the physicians and nurses (group I) (p < 0.05). Group II patients had a higher total knowledge score, but they were no better in risk factors, weight control, or calculated dietary fat or cholesterol. There was no correlation between time spent and percentage of calories from fat or total test score. Six weeks after the program instruction the mean cholesterol level for all the participants was reduced, and group II had a lower fat intake than did group I, which was associated with significantly lower serum cholesterol, not present at entry. CONCLUSION: Primary care physicians and their office nurses, using less time than do dietitians, can be effective educators in providing patient education for coronary risk reduction and dietary fat intake. A second formal dietary consultation appears beneficial in improving compliance and lipid control.

Cholesterol↗

PubMed2002

School-based violence prevention programs: systematic review of secondary prevention trials.

OBJECTIVE: To quantify the effectiveness of school-based violence prevention programs for children identified as at risk for aggressive behavior. DESIGN: Systematic review and meta-analysis of randomized controlled trials. Electronic databases and bibliographies were systematically searched and authors and organizations were contacted to identify randomized controlled trials. Standardized, weighted mean effect sizes were assessed by meta-analysis. SETTING: Elementary, middle, and high schools. PARTICIPANTS: Children at risk for aggressive behavior. MAIN OUTCOME MEASURES: Violent injuries, observed or reported aggressive or violent behaviors, and school or agency responses to aggressive behaviors. RESULTS: Of the 44 trials identified, none reported data on violent injuries. For the 28 trials that assessed aggressive behaviors, the pooled difference between study groups was -0.36 (95% confidence interval, -0.54 to -0.19) in favor of a reduction in aggression with intervention. For the 9 trials that reported data on school or agency responses to aggression, the pooled difference was -0.59 (95% confidence interval, -1.18 to 0.01). Subgroup analyses suggested greater effectiveness in older students and when administered to mixed-sex groups rather than to boys alone. CONCLUSIONS: School-based violence prevention programs may produce reductions in aggressive and violent behaviors in children who already exhibit such behavior. These results, however, need to be confirmed in large, high-quality trials.

Adolescent↗

PubMed2004

Interventions for promoting smoking cessation during pregnancy.

BACKGROUND: Smoking remains one of the few potentially preventable factors associated with low birthweight, preterm birth and perinatal death. OBJECTIVES: To assess the effects of smoking cessation programs implemented during pregnancy on the health of the fetus, infant, mother, and family. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Tobacco Addiction Group trials register (July 2003), MEDLINE (January 2002 to July 2003), EMBASE (January 2002 to July 2003), PsychLIT (January 2002 to July 2003), CINAHL (January 2002 to July 2003), and AUSTHEALTH (January 2002 to 2003). We contacted trial authors to locate additional unpublished data. We handsearched references of identified trials and recent obstetric journals. SELECTION CRITERIA: Randomised and quasi-randomised trials of smoking cessation programs implemented during pregnancy. DATA COLLECTION AND ANALYSIS: Four reviewers assessed trial quality and extracted data independently. MAIN RESULTS: This review included 64 trials. Fifty-one randomised controlled trials (20,931 women) and six cluster-randomised trials (over 7500 women) provided data on smoking cessation and/or perinatal outcomes. Despite substantial variation in the intensity of the intervention and the extent of reminders and reinforcement through pregnancy, there was an increase in the median intensity of both 'usual care' and interventions over time. There was a significant reduction in smoking in the intervention groups of the 48 trials included: (relative risk (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.95), an absolute difference of six in 100 women continuing to smoke. The 36 trials with validated smoking cessation had a similar reduction (RR 0.94, 95% CI 0.92 to 0.95). Smoking cessation interventions reduced low birthweight (RR 0.81, 95% CI 0.70 to 0.94) and preterm birth (RR 0.84, 95% CI 0.72 to 0.98), and there was a 33 g (95% CI 11 g to 55 g) increase in mean birthweight. There were no statistically significant differences in very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. One intervention strategy, rewards plus social support (two trials), resulted in a significantly greater smoking reduction than other strategies (RR 0.77, 95% CI 0.72 to 0.82). Five trials of smoking relapse prevention (over 800 women) showed no statistically significant reduction in relapse. REVIEWERS' CONCLUSIONS: Smoking cessation programs in pregnancy reduce the proportion of women who continue to smoke, and reduce low birthweight and preterm birth. The pooled trials have inadequate power to detect reductions in perinatal mortality or very low birthweight.

Female↗

PubMed1984

Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Dietary Intervention Study of Hypertension.

The possibility exists that dietary modification may increase the number of patients who remain normotensive after drug withdrawal. In an effort to resolve this question, former Hypertension Detection and Follow-up Program Stepped Care participants (n = 496) were randomized into four major groups at the end of the programme (greater than 5 years antihypertensive therapy): controls (continue medication); discontinue medication, no dietary intervention; discontinue medication and weight loss; discontinue medication and reduce sodium. Groups 1, 2 and 4 were further divided into obese (greater than or equal to 120% ideal weight, and non-obese groups). The weight reduction group (greater than or equal to 120% ideal weight) lost 10.1 +/- 11 lbs without changing dietary sodium (n = 87). The sodium restriction group reduced urine sodium excretion from 145 to 97 mEq per day (n = 169). Sixty per cent of the weight loss group were normotensive at 56 weeks compared to 35% withdrawn from medication without dietary intervention. The highest 56 weeks success rates were in the mild non-overweight hypertensives on sodium restriction (78%), and the mild overweight hypertensives on weight reduction (72%). Randomization to either weight loss group or sodium restriction group increased the likelihood of remaining off drugs (adjusted odds ratio of 3.43 for the weight group and 2.17 for the sodium group (P less than 0.05). Age, severe hypertension greater than 5 years previous to entry into Dietary Intervention Study of Hypertension (DISH) or need for several drugs increased the chance of failure.

Adult↗

PubMed2005

Gender-related changes in body composition, muscle strength and power output after a short-term multidisciplinary weight loss intervention in morbid obesity.

Obese men and women have notably different body composition, which contributes to a different functional motor impairment, but it is unknown whether they respond differently to the same intervention for body weight (BW) reduction and motor capability improvement. The aim of this investigation was to compare changes in body composition, strength production and power output observed in severely obese men and women after a BW reduction intervention, and to test the hypothesis that changes in body composition may be related to changes in motor functionality. Ninety-five obese men and women of the same age (29.3 +/- 7.0 SD yr) and body mass index (41.2 +/- 4.4 kg/m2) participated in a short-term (3 week) mass reduction program (5 days/week) entailing exercise (aerobic and strength training) and energy-restricted diet. BW and body composition, maximum voluntary total isotonic strength (ST), and maximum leg power output (W) were evaluated before and after the program. After the intervention, BW decreased significantly in both men and women, but males lost a significantly higher amount of their initial BW than females (5.12 +/- 0.91 vs 4.27 +/- 1.42%, p<0.01). In men the BW loss was composed by a similar amount of fat mass (FM) and fat-free mass (FFM), whereas women lost FM almost entirely. Both men and women significantly improved ST after the intervention, but no difference in improvement was detected between genders, while W increased significantly in females (p<0.001), and no change was detected in males, although W per unit BW and FFM increased significantly in both genders (p<0.05-0.001). In spite of the positive correlation of ST and W with FFM (p<0.001), there was no detectable relation between the changes in body composition and those in motor performance, the improvement in ST and W being better attributable to factors other than muscle mass change. The present diet/exercise intervention induced significant effects on BW changes and composition as well as on ST and W, with a different impact in males and females.

Adult↗

PubMedDate not supplied

Infant mortality: agenda for the 1990s.

The relatively high infant mortality rate in the United States has remained stable during the last few years largely as a result of the steady rate of infants born with low birth weight. Further reductions in the infant mortality rate depend on the prevention of low birth weight births and improved quality of health in the first year of life. Groups such as the National Commission to Prevent Infant Mortality, the Institute of Medicine, and the American Nurses' Association have outlined steps for professionals and for the public and private sectors. PNPs are vital to this effort through clinical practice, program development, advocacy, and research.

Child Health Services↗