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At least 19 recordsLinked to original sources
PubMedDate not supplied

Coping, life-style changes, health perceptions, and martial adjustment in middle-aged women and men with cardiovascular disease and their spouses.

This descriptive study was designed to compare the coping responses, life-style changes, health perceptions, and current marital adjustment in 11 middle-aged women (CD women) with those of 37 men (CD men) who had been diagnosed as having cardiovascular disease. A secondary purpose was to compare their spouses' responses on these same measures. Participants were comparable on demographic and illness characteristics. CD women differed from CD men for the three coping responses of distancing, accepting responsibility, and planful problem-solving; for the total health perceptions scale; and for the current health and resistance to illness subscales. The CD women and CD men differed from their partners in total health perceptions, current health, and resistance to illness. CD women and their husbands were more dissimilar in their coping responses than were CD men and their wives. Age and pre-illness satisfaction were significant predictor variables for the coping strategies of distancing and accepting responsibility.

Adaptation, Psychological↗
PubMed1992

Life style changes improve insulin resistance in hyperinsulinaemic subjects: a one-year intervention study of hypertensives and normotensives in Dalby.

OBJECTIVE: Insulin resistance and hyperinsulinaemia are, in some prospective studies, linked to an increased cardiovascular risk, at least in men. We tested the hypothesis that hyperinsulinaemia may be reduced by non-pharmacological methods independently of other cardiovascular risk factors. DESIGN: In a non-pharmacological intervention study for 1 year three groups of subjects (hypertensives as well as normotensives) were selected after stratification for insulin level at baseline. Half of the hyperinsulinaemic subjects were randomly assigned to active intervention with physical exercise and dietary regulation (HI-A group), the other half were followed passively during the study period (HI-P group). Normo-insulinaemics and hypo(low)-insulinaemics also underwent active intervention (NI-A and LI-A groups, respectively). SETTING: Primary health care in Sweden. RESULTS: During the 1-year follow-up subjects in the HI-A group reduced their weight, waist:hip ratio and systolic and diastolic blood pressure, as well as their low:high-density lipoprotein (LDL:HDL)-cholesterol ratio. Glucose levels before and during an oral glucose tolerance test did not change. However, plasma insulin and plasma-C-peptide decreased both in the fasting state and after 1 and 2 h of oral glucose tolerance testing. This decrease was independent of the previously mentioned reduction in weight, waist:hip ratio, blood pressure and LDL:HDL-cholesterol ratio. No reduction in insulin levels was seen in the HI-P, NI-A or LI-A groups, but in the HI-P group there was a slight decrease in fasting plasma-C-peptide levels. In the HI-A group dietary improvements were observed during the study period, with a reduction in energy intake, fat consumption and cholesterol intake. Fibre intake was increased. No major changes were seen in the HI-P group. CONCLUSIONS: We conclude that in hypertensive and normotensive subjects with hyperinsulinaemia insulin levels can be reduced by active non-pharmacological treatment for 1 year without altering glucose tolerance. This shows that insulin resistance may be lowered by non-pharmacological treatment, which may be of considerable importance, and not only for hypertensives.

Adult↗
PubMed1992

Effect of nutrition on the health of the elderly.

Nutrition may play a role in the progressive decline of several body functions with aging. Progressive decline in energy, lean body mass, and protein intake are also associated with aging. Many elderly (greater than 55 years old) drink less than the recommended amounts of water and consume less than the Recommended Dietary Allowances of calcium, iron, zinc, copper, thiamin, riboflavin, folate, and vitamins B-12 and D. Nutrition needs of the elderly to maintain activities of daily living are expected to increase in future years. Because diminished physical activity and old age disabilities cause the elderly to modify eating habits acquired at a younger age, dietary and other life-style changes should be implemented early in life so that optimal tissue function will be maintained. More research and development is needed in the areas of nutrient requirements for the elderly, effect of nutrition on chronic diseases, improved methods for assessing nutritional status and screening the elderly for nutritional risk, nutrient-nutrient and nutrient-drug interactions, and educational strategies to provide better nutrition and eliminate health fraud. Dietary interventions show promise, but must be monitored for effectiveness.

Aged↗
PubMed1992

Challenging commonly held beliefs about obesity.

The task of nurses is to diagnose and treat human responses to illness and the threats of illness. The challenge is in finding the correct diagnosis and selecting the appropriate treatment. To do this appropriately, nurses need to separate health and illness from life-style; to discover whether or not life-style changes are really called for in treating illness or threats of illness or if nurses are uncomfortable with life-styles that are different from their own and expect all people to have a life-style similar to theirs. To intervene appropriately, nurses need to know whether they are working to help others return to their life-style preference or are forcing patients to chose the nurses' life-style preference. The case of the obese and the search for the successful dieter exemplifies the health care system's need to have individuals follow an exercise and eating program to lead them to thinness (a cultural value) whether or not they value thinness. Are health professionals forcing patients to conform to the professionals' life-style rather than assisting them to a healthier state within their own?

Attitude to Health↗
PubMed1992

Hassles, life events, and health status among Chinese college students in Hong Kong.

Major life events and daily hassles were examined in a sample of 102 university undergraduates. While the major clusters of events were related to personal loss, life-style changes, family conflict, and personal insecurity, those of hassles were related to drudgery and uncontrollable environmental irritants, personal concerns, time and work management, minor routine expenses, and the dilemma of emigration. Using life events and hassles, and hassle clusters added significantly to the sensitivity of the concurrent prediction of undifferentiated and differentiated physical and psychological symptom criteria, and consistently showed better performance as predictors. However, the independent contributions of events and event clusters could hardly be discounted. The combined effects of major discrete and minor chronic stress on health status and the limitations of the present retrospective study were discussed.

Adolescent↗
PubMed1992

The "big three" cardiovascular risk factors among American blacks and Hispanics.

Today's chronic diseases require "treatment" by shifting control of the outcome from the provider back to the individual and the environment in which one functions. There is a strong need to consider the individual in the context of ethnicity and culture, which express themselves in the prevalence and magnitude of risk factors, the biological impact of risk factors and expression of disease, and the potential for control of unhealthy behaviors. Educational and screening programs related to the risk factors of cigarette smoking, hypertension, and cholesterol must be structured so that recommended life-style changes are compatible with the individual's cultural values and beliefs.

Adolescent↗
PubMedDate not supplied

Photography as a tool in assessment and rapport development in clients with diabetes: research brief.

Certainly no major conclusions or generalizations can be made from a pilot study of this size. However, as is the nature of pilot studies, needed modifications in methodology have been discovered. Also, it is obvious that rapport development may be evaluated with the MISS, and the use of a camera has proven to be a worthwhile assessment and intervention tool. The results of this pilot study would certainly warrant continuation with a larger study. Rapport development has not been studied in diabetes. Perhaps rapport may be at risk because of the lengthy provider-patient relationship and the need for repeated physician reinforcement of required medical regimens and some associated life-style changes. In this study, rapport appeared to increase slightly in the experimental (camera) group and decrease in the control (non-camera) group. From the patients' perspective, use of photography communicates that the health care provider cares about them as individuals, is interested in their life-styles, and is seeking methods to best integrate the treatment regimen into their individual life patterns. However, rapport development may deteriorate over time with individuals who have a chronic illness (as indicated by some decrease in pretest/posttest mean differences in both groups), thus emphasizing the responsibility of health care providers to actively work to preserve rapport. The camera may be one method to accomplish this goal. When treating an individual with a chronic illness, health care providers tend to view the patient and problem as one entity rather than as two separate components. The camera may help to enhance this separation and promote understanding of the individual by means of rapport development.

Adult↗
PubMedDate not supplied

Personal determinants of health promoting behavior.

This paper describes the personal determinants in health promoting behavior, and, in particular, life style changes. A review is made of internal factors, including personality factors, health beliefs, and health attitudes. Environment factors are also taken into account. Suggestions for future research are proposed.

Attitude to Health↗
PubMedDate not supplied

Living with a permanent cardiac pacemaker.

Responses of 30 cardiac pacemaker recipients showed that 90 per cent were aware of warning signs and symptoms prior to pacemaker implantation, but only 37 per cent sought medical attention when the initial warning signs were evident. The group which sought care experienced more symptoms per patient than the other groups which did not seek early treatment. The most commonly occurring symptoms experienced by the patients prior to pacemaker insertion were blackouts and slow regarding pacemaker implantation were made by the physician alone. Patients took inventory after implantation, and 60 per cent reported that they were fortunate to have received a pacemaker. During the inventory and long-term recovery stages, patients who thought they had experienced few life-style changes after receiving a cardiac pacemaker reported positive feelings about living with a cardiac pacemaker. Many of the patients' problems in adjusting to a permanently implanted cardiac pacemaker and participating in its maintenance were related to a lack of accurate information about what to expect or how to assure normal functioning of the pacemaker.

Adult↗
PubMed1992

The influence of dietary change on hemostatic risk variables.

In the 1970s in the Diet-Antismoking Trial, of the Oslo Study, colleagues and I found that the majority of high-risk men with elevated serum cholesterol and elevated triglyceride concentrations had impaired fibrinolytic capacity. Later on, both our group and others found a similar negative correlation between serum triglyceride levels and fibrinolytic capacity. Furthermore, in a prospective study of dietary intervention in individuals with both elevated cholesterol and triglyceride levels, we found that dietary lowering of serum triglyceride levels was significantly and positively correlated with an improvement in fibrinolytic capacity. In another study, we made the same observation for the coagulation factor VII-phospholipid complex: the more the triglycerides were reduced by diet, the greater was the change in factor VII complex. This correlation was highly significant and independent of changes in serum cholesterol. Platelet function is also influenced by dietary habits, but except for the effects of a fish oil-enriched diet, few data are available about the dietary effects on platelet function. It seems, however, that in individuals with elevated lipid levels and elevated blood pressure, increased platelet reactivity is a highly prevalent finding. Many of the hemostatic risk variables are associated with the so-called "metabolic risk syndrome" characterized by an increase in serum insulin level, together with increased relative body weight, mild hypertension, hyperlipidemia, and physical inactivity. This syndrome can often be influenced favorably by life-style changes. A controlled study with interventions in diet and activity level has just been started by our group.

Adult↗
PubMed1979

Prevention: rhetoric and reality.

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

Activities of Daily Living↗
PubMed1992

Diabetes, exercise, and atherosclerosis.

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

Arteriosclerosis↗
PubMed1992

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

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

Activities of Daily Living↗
PubMed1992

Personality disorders in obsessive compulsive disorder.

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

Comorbidity↗
PubMed1992

[Economic aspects of therapy for lipid metabolism disorders].

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

Cholesterol↗
PubMed1979

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

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

Adolescent↗