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PubMedDate not supplied

Survey of smoking patterns, attitudes, and interest in quitting.

We conducted a survey of 875 smokers in a Minnesota Heart Health Program community who were nonparticipants in screening and intervention. We found particular levels of interest in quitting and in formal cessation topics and programs among these smokers. Also, we collected information on smoking history, social environment, and anticipated barriers to quitting. Most noteworthy was the finding that more than half of the respondents indicated a desire to be contacted by telephone to receive information on materials on, classes on and ways of quitting smoking. Topics of particular interest to smokers included physical addiction, stress reduction, and (for women) methods of avoiding weight gain after quitting. Only 7% of respondents reported that they definitely did not want to quit, and approximately one-third of those interested in quitting indicated that they would seek outside help in doing so. The findings support the viability of "reverse" helpline procedures in which smokers are contacted directly and offered assistance in quitting.

Adult↗

PubMed1982

Effectiveness of intensive care of very low birth-weight infants.

Perinatal/neonatal intensive care can be evaluated in terms of its efficacy, effectiveness and efficiency. There is good experimental evidence from randomized controlled clinical trials that intensive-care interventions in the perinatal period are efficacious in reducing perinatal/neonatal mortality and fetal/neonatal morbidity. The effectiveness of intensive care programs in large populations has not been tested experimentally. However, population surveys show that perinatal/neonatal mortality is declining and it is likely that this is due in large part to improved perinatal care. Moreover, low birth-weight infants born in Level 3 hospitals have a lower neonatal mortality rate than LBW infants born in hospitals that are less well staffed and equipped. The true size of the reduction in fetal/neonatal mortality that is attributable to perinatal interventions is difficult to estimate from the experience of referral hospitals because of selection bias (both postnatal and prenatal). Thus, the size of the reduction in mortality resulting from the intensive care of VLBW infants is quite striking in hospital-based studies, but more modest in area-based studies. The efficiency of perinatal interventions in reducing death and disability takes into consideration both the health outcomes and the costs attributable to perinatal intensive care. Although neonatal intensive care saves lives, it is doubtful that the rate of handicap in very low birth-weight infants has been much affected. The immediate and long-term costs of neonatal intensive care are high, but a systematic economic evaluation has not yet been published.

Persons with Disabilities↗

PubMed1995

Emerging issues in lifestyle, social, and environmental interventions to promote behavioral change related to prevention and control of hypertension in the African-American population.

Prevention of hypertension must play a more prominent role in health care, in the education of young people, and in the public policy arena if we are committed to reduce mortality from cardiovascular disease. Some steps individuals can take to lessen the risk of stroke or coronary heart disease include: If you are obese and hypertensive, you should reduce total calories and lose weight. Substitute olive oil or canola oil for vegetable oils to increase your intake of monounsaturated fatty acids. Try the Mediterranean diet. Start a program of aerobic exercise or increase the amount you are currently doing. Reduce salt intake. Reduce alcohol consumption. Stop smoking. If you have hypertension and tend to overrespond to stress, try relaxation and biofeedback techniques, which according to some studies may produce a modest reduction in blood pressure in some individuals with mild hypertension. Increase the amount of fiber in the diet by increasing the amount of grains, fruit, and vegetables. Have your renin level tested. A "population" approach should be incorporated into medical school curricula to encourage and train caregivers to consider social, cultural, and economic factors affecting patients. Historically black colleges, public and private elementary and secondary schools, and churches can provide leadership in this nation for educating African Americans in the prevention and control of high blood pressure. In conclusion, we already have the information we need from research to close the mortality gap between whites and African Americans in cardiovascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗

PubMed2006

What women want: understanding obesity and preferences for primary care weight reduction interventions among African-American and Caucasian women.

PURPOSE: To explore attitudes and perceptions of obesity, and identify preferences for weight-management interventions by African-American and Caucasian women who were followed in general internal medicine clinics. PROCEDURE: Surveys exploring these issues were mailed to African-American (n=240) and Caucasian (n=240) women with a BMI of > or =30. MAIN FINDINGS: Caucasian women felt past weight-loss efforts were helped by weight-loss programs significantly more than African-American women (P<0.001); African-American women were more likely to feel that their cultural background contributed to their weight gain than did Caucasian women (P=0.001). African-American women expressed a higher need for one-on-one counseling with their physician (P<0.001) as well as group meetings with the dietician, physician and other women (P=0.004) than did Caucasian women. African-American women also felt it was more important for weight-loss programs to have information on food common to their culture than did Caucasian women (P<0.001). CONCLUSIONS: Differences in cultural background and preferences about weight loss interventions have important policy implications for how the U.S. healthcare system provides care to an ever-increasing multicultural population with a national epidemic such as obesity.

Black or African American↗

PubMed2003

Epidemiology of the insulin resistance syndrome.

The insulin resistance syndrome consists of the co-occurrence of metabolic risk factors for type 2 diabetes and cardiovascular disease, including overall obesity, central obesity, dyslipidemia (characterized by elevated levels of triglycerides and low levels of high-density lipoprotein cholesterol), hyperglycemia, and hypertension. Using criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III, national survey data suggest the insulin resistance syndrome is very common, affecting about 24% of US adults aged greater than 20 years. The syndrome is more common in older people and in Mexican Americans, and will increase in prevalence as populations age and become more obese. Identification of the syndrome warrants aggressive interventions known to prevent type 2 diabetes and cardiovascular disease, including weight reduction, increased physical activity, and control of hypertension and dyslipidemia.

Cardiovascular Diseases↗

PubMed1998

A multi-level model of data with repeated measures of the effect of lamb diarrhoea on weight.

Over a 1-year period, data were collected from three flocks of sheep. A total of 213 lambs were examined routinely from birth to 32 kg (2178 examinations in total). Diarrhoea was seen in lambs of all ages but did not appear to make them systemically ill. The effect of diarrhoea on lamb weight was investigated using MLn, a multi-level modeling program. The data were set at three hierarchical levels: level one, the repeated examinations on each lamb; level two, the lamb; and level three, the litter. Age, the quadratic of age, litter size, sex and farm of origin, all had significant effect on the weight of the lambs. There was also significant random variation in examinations within lambs, between individual lambs and between litters of lambs. There was a reduction in absolute weight of lambs for each week until four weeks after an episode of diarrhoea.

Animals↗

PubMed2000

Perceived pain before and after three exercise programs--a controlled clinical trial of women with work-related trapezius myalgia.

The effect of exercise on neck-shoulder pain was studied in 103 women with work-related trapezius myalgia randomized into three exercise groups and a control group. One group trained strength, the second muscular endurance and the third co-ordination. The exercise groups met three times weekly for 10 weeks. Pain assessment was made on three visual analogue scales, indicating pain at present, pain in general and pain at worst. Pain thresholds were measured in the trapezius muscle with a pressure algometer. A pain drawing was completed. The rated pain decreased significantly (P<0.05) on the VAS describing pain at worst in the strength and endurance groups. Pressure sensitivity decreased significantly (P<0.05) in four triggerpoints in the exercise groups. No changes were seen in the extent of painful body area in any group. Comparison of exercisers (n=82) and controls (n=21) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers. All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction.

Adult↗

PubMed2005

Acetone oxidation using ozone on manganese oxide catalysts.

Supported manganese oxide catalysts were prepared by the impregnation of alumina foam blocks washcoated with alumina and silica. The manganese content based on the weight of the washcoats was 10 wt % calculated as MnO2. Fourier transform profiles of the Mn K-edge EXAFS spectra for these samples gave three distinctive peaks at 0.15, 0.25, and 0.32 nm and were close to the profiles of Mn3O4 and beta-MnO2. The number of surface active sites was determined through oxygen chemisorption measurements at a reduction temperature (Tred = 443 K) obtained from temperature-programmed reduction (TPR) experiments. Acetone catalytic oxidation was studied from room temperature to 573 K, and was found to be highly accelerated by the use of ozone on both catalysts with substantial reductions in the reaction temperature. The only carbon-containing product detected was CO2. The alumina-supported catalyst was found to be more active than the silica-supported catalyst in acetone and ozone conversion, with higher turnover frequencies (TOFs) for both reactions. The pressure drop through the foam was low and increased little (0.003 kPa/10 000 h(-1)) with space velocity. In situ steady-state Raman spectroscopy measurements during the acetone catalytic oxidation reaction showed the presence of an adsorbed acetone species with a C-H bond at 2930 cm(-1) and a peroxide species derived from ozone with an O-O bond at 890 cm(-1).

Acetone↗

PubMedDate not supplied

Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review.

PURPOSE: To summarize currently existing evidence regarding prosthetic replacement for the treatment of intertrochanteric (extracapsular) hip fractures and their complications. METHOD: Report of a clinical investigation program conducted at one academic institution and literature review. RESULTS: Although the majority of intertrochanteric fractures can be successfully managed with operative reduction and fixation, some patients may benefit from prosthetic replacement. For older patients with severe osteoporosis or comminution there are some definite advantages of prosthetic replacement over reduction and fixation. If the prosthetic replacement has been properly performed, there is very little concern over immediate ambulation and weight-bearing. This decreases the incidence of postoperative complications, such as pulmonary infection, atelectasis, and pressure sores. In addition, acute prosthetic replacement eliminates the possibility of excessive collapse compromising walking function, mal-union, as well as the uncommon problems of non-union and avascular necrosis. Likewise, hip arthroplasty is an effective salvage procedure after the failed internal fixation of an intertrochanteric fracture in an older patient. Most patients report good pain relief, and surprisingly few serious orthopaedic complications are associated with this procedure.There are, however, a number of methodological concerns regarding previous studies which have examined the use of prosthetic replacement for the treatment of comminuted intertrochanteric fractures or non-union in the elderly patient. Many have been small case series without a control group. There are few comparative studies and even fewer prospective, randomized controlled trials which have compared prosthetic replacement surgery with standard internal fixation techniques in the long run. CONCLUSIONS: Older patients with severe osteoporosis or comminution may benefit from prosthetic replacement to treat intertrochanteric fractures and non-unions. Overall, rigorously conducted prospective randomized clinical trials with long-term follow-up are lacking. Despite these methodological reservations, several authors have reported successful prosthetic replacement for treating intertrochanteric fractures and their complications in elderly patients. Few serious orthopaedic complications are associated with these procedures, and most patients have good pain relief.

Aged↗

PubMed1996

A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids.

A double-blind crossover study comparing the effect of aged garlic extract with a placebo on blood lipids was performed in a group of 41 moderately hypercholesterolemic men [cholesterol concentrations 5.7-7.5 mmol/L (220-290 mg/dL)]. After a 4-wk baseline period, during which the subjects were advised to adhere to a National Cholesterol Education Program Step I diet, they were started on 7.2 g aged garlic extract per day or an equivalent amount of placebo as a dietary supplement for a period of 6 mo, then switched to the other supplement for an additional 4 mo. Blood lipids, blood counts, thyroid and liver function measures, body weight, and blood pressure were followed over the entire study period. The major findings were a maximal reduction in total serum cholesterol of 6.1% or 7.0% in comparison with the average concentration during the placebo administration or baseline evaluation period, respectively. Low-density-lipoprotein cholesterol was also decreased by aged garlic extract, 4% when compared with average baseline values and 4.6% in comparison with placebo period concentrations. In addition, there was a 5.5% decrease in systolic blood pressure and a modest reduction of diastolic blood pressure in response to aged garlic extract. We conclude that dietary supplementation with aged garlic extract has beneficial effects on the lipid profile and blood pressure of moderately hypercholesterolemic subjects.

Adult↗

PubMed1995

Physician and patient prevention practices in NIDDM in a large urban managed-care organization.

OBJECTIVE: To examine physician and patient adherence to prevention guidelines in non-insulin-dependent diabetes mellitus (NIDDM) with attention to possible differences in adherence by patient race or ethnicity. RESEARCH DESIGN AND METHODS: We performed a cross-sectional chart review study of prevention practices, complications, and risk factors in 378 NIDDM patients (at least 5 years known duration) who were Permanente Medical Care Program, Oakland, CA. There were 232 blacks, 81 whites, 29 Hispanics, and 36 members of other races/ethnicities. RESULTS: Age- and duration-adjusted prevalence of 14 complications was low and, with the exception of diabetic retinopathy, did not differ significantly by race. An eight-point prevention score that reflected recommended use of glucose, HbA1c, high-density lipoprotein/total cholesterol, blood pressure and proteinuria testing, ophthalmology a and foot examinations, and diabetes education during a 2-year period did not differ by race/ethnicity (P = 0.36). The mean score (4.9 +/- 1.6) indicated that on average, five of eight guidelines were performed appropriately. Compliance was poorest for annual proteinuria checks (32.2%). No differences were noted by race/ethnicity in referrals to ophthalmology, weight reduction, or smoking cessation or in missed appointments or failure to keep referral visits. CONCLUSIONS: The absence of racial differences in either prevention practices or complication rates in this insured prepaid setting suggests that improved access to preventive services may be effective in reducing such differences nationally. However, adherence to several guidelines was < or = 50%, indicating that physicians are not sufficiently convinced of the necessity for these prevention measures.

Black or African American↗

PubMed1988

Influence of moderate exercise on glucose homeostasis and serum testosterone in young men with low HDL-cholesterol level.

Fifty-five healthy sedentary non smoking and non obese 24-26-year-old men with a low serum concentration of HDL-cholesterol were selected for a study of the effect of nine weeks of exercise on glucose homeostasis, and blood testosterone. The participants were randomized into two groups. Twenty-eight subjects were assigned to a nine-week program of submaximal aerobic exercise three times weekly, while 27 were assigned to a non exercising control group. The improvement in physical fitness was assessed by change in estimated oxygen consumption (EVO2 max) that was increased by 15% in the exercise group (p less than 0.001), but remained unchanged in the control group. During the study the body weight of both groups remained essentially unchanged. There was a significant reduction of mean plasma fructosamine in the exercise group, and non significant reduction in serum insulin. Serum testosterone, glycohemoglobin and HDL-cholesterol were not influenced by exercise, while serum triglycerides were significantly reduced.

Adult↗

PubMed1985

[Morphologic findings during regression of heart hypertrophy].

The heart is capable of adapting to widely different loads. Increased load will cause hypertrophy with thickening and elongation of the cardiac muscle cells. Beyond the critical heart weight hyperplasia will develop in man. The volume ratio of mitochondria and myofibrils as well as the volume of interstitial tissue and capillaries depends on the type of hypertrophy (training, volume or pressure overload). Hypertrophy will regress when its cause is removed. Training: In experiments with rats 80% of an increase in heart weight caused by swimming was reduced within 14 days after the training program had been stopped. During this time the size of heart muscle cells and the volume ratio of cell organelles had almost completely normalized. From quantitative morphological and biochemical studies, it is supposed that a reduced synthesis but not an obvious increase of catabolism is important in the regression of cardiac hypertrophy. A significant increase in capillary density during the regression period suggests that more time is needed for the regression of capillary length than is required by muscle cells. Training will cause harmonious growth of the left and right chamber wall. During the regression period no quantitative differences of left and right ventricular wall were observed. Pressure overload: Regression of pressure induced hypertrophy is characterized by a reduction of the muscle cell size but not of the amount of collagen in the interstitium. Preliminary studies on pig hearts with an over 100% increase of the weight of their right chamber wall caused by slowly rising pressure load using ameroid constrictors on the A. pulmonalis have shown a 60% reduction of the weight of the right ventricular wall 10 days after removing the constrictor. A reduced mitochondria/myofibrillar ratio becomes normalized. An incomplete or even lacking reduction of the heart weight in rats with spontaneous hypertension (SHR) after therapeutic depression of blood pressure suggests that other factors besides elevated blood pressure are important for inducing hypertrophy in these rats. Valve replacement: An incomplete reduction of heart weight can be observed in patients even after replacement of damaged cardiac valves. Extensive morphological studies on these hearts disclosed recidive infarction or a high degree of cardiac fibrosis as the cause of irreversible hypertrophy. It is still not known whether a case of hypertropied heart with hyperplasia regression will be accompanied by a reduction of the number of myocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2004

The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disorders among nursing assistants at a state-run veterans' home.

Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.

Ergonomics↗

PubMed2005

Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the diabetes prevention program: effects of lifestyle intervention and metformin.

Insulin resistance and beta-cell dysfunction, two factors central to the pathogenesis of type 2 diabetes, were studied in relation to the development of diabetes in a group of participants with impaired glucose tolerance in the Diabetes Prevention Program (DPP) at baseline and after specific interventions designed to prevent diabetes. Participants were randomly assigned to placebo (n = 1,082), metformin (850 mg twice a day) (n = 1,073), or intensive lifestyle intervention (n = 1,079). The diabetes hazard rate was negatively associated with baseline insulin sensitivity (hazard rate ratio = 0.62-0.94 per SD difference, depending on treatment group and measure of sensitivity) and with baseline insulin secretion (hazard rate ratio = 0.57-0.76 per SD). Improvements in insulin secretion and insulin sensitivity were associated with lower hazard rates in all treatment arms (hazard rate ratio = 0.46-0.95 per SD increase and 0.29-0.79 per SD increase, respectively). In multivariate models that included the three metabolic variables (changes in body weight, insulin sensitivity, and insulin secretion) each significantly and independently predicted progression to diabetes when adjusted for the other two variables. The intensive lifestyle intervention, which elicited the greatest reduction in diabetes incidence, produced the greatest improvement in insulin sensitivity and the best preservation of beta-cell function after 1 year, whereas the placebo group, which had the highest diabetes incidence, had no significant change in insulin sensitivity and beta-cell function after 1 year. In the metformin group, diabetes risk, insulin sensitivity, and beta-cell function at 1 year were intermediate between those in the intensive lifestyle and placebo groups. In conclusion, higher insulin secretion and sensitivity at baseline and improvements in response to treatment were associated with lower diabetes risk in the DPP. The better preventive effectiveness of intensive lifestyle may be due to improved insulin sensitivity concomitant with preservation of beta-cell function.

Adult↗

PubMed1997

Enhancement of compliance among patients with hypertension.

Studies of patient compliance with medical advice consistently demonstrate a high level of noncompliance. Not following recommendations can have serious negative consequences in the management of disease. This study was an assessment of the effect on compliance of a longitudinal, individualized educational program for patients with hypertension in a managed care setting. A before-and-after self-paired design was used to assess the behavior of 107 patients with hypertension. Trained nurses using an interactive interview format reinforced prescribed treatment and provided appropriate printed material to participants. Brief telephone follow-up interviews at prescribed intervals were used to elicit problems, provide additional education, and reinforce compliance behaviors. Most of the patients who participated showed a statistically significant (P < 0.01) decrease in both systolic and diastolic blood pressure. There was also an effect on various recommended behaviors, including compliance with medication taking, ideal body weight, salt restriction, stress, and exercise. A statistically significant relation existed between improved compliance with individual behavior changes and decreased blood pressure (P < 0.01). Elderly persons were particularly likely to show statistically significant reductions in blood pressure (75.4% versus 50.0%). A chi 2 test indicated that those differences were significant at the 0.01 level. A relatively inexpensive, office-based educational protocol can have a statistically significant effect on treatment compliance among patients with hypertension. The intervention has particular implications for geriatric patients, whose high blood pressure is disproportionately represented.

Adult↗

PubMed1997

Effects of exercise involving predominantly either joint-reaction or ground-reaction forces on bone mineral density in older women.

This study compared the effects of two exercise training programs, 11 months in duration, on bone mineral density (BMD) in older, sedentary women. Thirty-nine women, aged 60-74 years, were assigned to the following groups: (a) a group that performed exercises that introduced stress to the skeleton through ground-reaction forces (GRF) (i.e., walking, jogging, stairs); (b) a group that performed exercises that introduced stress to the skeleton through joint-reaction forces (JRF) (i.e., weight lifting, rowing); or (c) a no-exercise control group. BMD of the whole body, lumbar spine, proximal femur, and distal forearm was assessed five times at approximately 3-month intervals. The GRF and JRF exercise programs resulted in significant and similar increases in BMD of the whole body (2.0 +/- 0.8% and 1.6 +/- 0.4%, respectively), lumbar spine (1.8 +/- 0.7% and 1.5 +/- 0.5%, respectively), and Ward's triangle region of the proximal femur (6.1 +/- 1.5% and 5.1 +/- 2.1%, respectively). There was a significant in BMD of the femoral neck only in response to the GRF exercise program (GRF, 3.5 +/- 0.8%; JRF, -0.2 +/- 0.7%). There were no significant changes in BMD in control subjects. Among all exercisers, there was a significant inverse (r = -0.52, p < 0.01) relationship between increases in whole body BMD and reductions in fat mass, suggesting a dose response effect of exercise on bone mass. Although femoral neck BMD was responsive only to the GRF exercise program, some adaptations (i.e., increase in lean body mass and strength) that were specific to the JRF exercise program may be important in preventing osteoporotic fractures by reducing the risk for falls. It remains to be determined whether all of these benefits can be gained through a training program that combines the different types of exercises employed in this study.

Aged↗

PubMed1999

Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH).

OBJECTIVE: To evaluate the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood low-density lipoprotein cholesterol levels in patients with hyperlipidemia. PARTICIPANTS AND METHODS: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician nutrition counseling training; and (3) physician nutrition counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3-hour training program on the use of brief patient-centered interactive counseling and the use of an office-support program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. RESULTS: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P<.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. CONCLUSION: Brief supported physician nutrition counseling can produce beneficial changes in diet, weight, and blood lipids.

Adult↗